Wheat dependent effort induced anaphylaxis T78.0

Anaphylactic symptoms following the consumption of foods containing wheat (see also wheat allergy), as well as subsequent physical exertion and possibly other co-factors such as psychological stress or medication (=summation anaphylaxis). Exercise-triggered wheat anaphylaxis (WDEIA) is the most common variant of food-dependent exercise-induced anaphylaxis (FDEIA) in Central and Northern Europe.

The clinical symptoms of the anaphylactic reaction do not differ from anaphylaxis of a different origin. However, it only occurs in combination with the above-mentioned factors.

It is not uncommon for WDEIA to manifest as chronic recurrent urticaria (Wagner 2016). This anaphylactic minus variant can also be provoked by oral provocation with wheat flour and subsequent exposure.

The clinical connection is not always obvious, as the symptoms can occur up to 6 hours after ingestion and the stress situation is not always obvious.

Medical history, skin tests with wheat flour (have a high diagnostic sensitivity), provocation tests with wheat-containing foods combined with subsequent relevant physical stress. Note: Experience has shown that specific IgE against wheat flour can be negative (!).

The omega-5-gliadin (Tri a 19) has proven to be a marker allergen in all WDEIA patients. IgE-mediated sensitization to omega-5-gliadin is detectable in 80% of these patients. Some patients also react to gamma-gliadin (Wolters P et al. 2022).

In recent years, results have been presented that indicate that non-gluten proteins that carry as yet unidentified allergenic epitopes also appear to be important for WDEIA (Gabler AM et al. 2022), e.g. in isolated cases the wheat LTP Tri a 14, which is known as the main allergen of baker's asthma.

All WDEIA patients should carry emergency medication, especially an adrenaline autoinjector for self-medication.

For WDEIA, a withdrawal period of up to 6 hours before physical activity is recommended. This also applies to the consumption of alcohol or NSAIDs. A change to a diet containing spelt is recommended. This conversion can fail if cross-reactions with other gluten-containing cereals (barley, rye, spelt) are known. In these cases a gluten-free diet should be aimed for.

1. Gabler AM et al. (2022) Basophil Activation to Gluten and Non-Gluten Proteins in Wheat-Dependent Exercise-Induced Anaphylaxis. Front Allergy 3:822554.
2. Haase O et al. (2014) Wheat-dependent exercise-induced anaphylaxis: Indication for component-resolved diagnostics. Allergo J 23: 72 German Allergy Congress 2014 (P52)
3. Hofmann C et al. (2015) Molecular diagnostics in food-dependent exercise-induced anaphylaxis. In: Kleine-Tebbe J et al. eds Molecular allergy diagnostics. Springer Verlag Berlin-Heidelberg S 245-225627.
4. Mohr J et al (2011) Wheat-dependent exercise-induced anaphylaxis (WDEIA): A diagnosis with obstacles. Abstract CD 46th DDG Conference: P02/09.
5. Wagner N et al. (2016) IgE-mediated wheat allergy presenting with the clinical picture of chronic urticaria. Allergo J int 25: 234-237
6. Wolters P et al. (2022) Lipid transfer protein allergy: characterization and comparison with birch pollen-associated food allergy. J Dtsch Dermatol Ges 20: 1430-1440.