A multicenter evaluation of diagnosis and management of omega-5 gliadin allergy (also known as wheat-dependent exercise induced anaphylaxis) in 132 adults

Publication date: Available online 1 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Lucinda Kennard, Iason Thomas, Krzysztof Rutkowski, Vian Azzu, Patrick FK. Yong, Bogusia Kasternow, Hannah Hunter, Naeema MO. Cabdi, Alla Nakonechna, Annette Wagner
BackgroundOmega-5 gliadin allergy (also known as wheat-dependent exercise induced anaphylaxis) is a rare allergy to wheat which often presents with intermittent severe anaphylaxis in the context of a co-factor, such as exercise.ObjectivesTo undertake a detailed clinical characterisation of the largest cohort of omega 5-gliadin allergic patients to date.MethodsWe retrospectively analysed the demographics, presentation, investigation and management of 132 patients presenting to 4 UK centres with omega-5 gliadin allergy.ResultsThere are significant delays to diagnosis of 1-5 years (40% of patients) and over 5 years (29% of patients). The most common cofactors were exercise (80%), alcohol (25%) and NSAIDs (9%). A minority of patients (11%) present without an identifiable cofactor. The level of specific IgE to omega-5 gliadin does not predict the severity of allergic reactions. Patients adhering to either a gluten-free diet or who avoid wheat in combination with exercise achieve the largest reductions in subsequent allergic reactions by 67% and 69%, respectively.ConclusionsOmega-5 gliadin allergy is a rare wheat allergy that presents with severe anaphylaxis. The diagnosis is frequently delayed, therefore we recommend that all adult patients presenting with anaphylaxis of unclear cause should have omega-5 gliadin specific IgE tested. A gluten-free diet or avoidance of wheat based meals in combination with exercise (if the cofactor is exercise) helps to significantly decrease the risk of future allergic reactions. However, antihistamines and an epinephrine auto-injector must always be prescribed, as a third of patients continue to have allergic reactions despite dietary advice.