WDEIA case series: Do unique clinical presentations suggest mechanistic differences?
Abstract
BACKGROUND: Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a rare but potentially severe delayed-onset food allergy occurring exclusively when wheat ingestion is accompanied by augmenting cofactors.
OBJECTIVE: This study aimed to characterize WDEIA, understand its varied clinical presentations, and propose mechanistic differences from classic food allergy.
METHODS: A retrospective chart review of patients diagnosed with WDEIA between 2017 and 2024 was performed in accordance with the Declaration of Helsinki. The clinical presentation, diagnosis, management strategies, and clinical course were analyzed.
RESULTS: The cohort consisted of 7 patients, aged 21 to 46 years (6 male and 1 female). All patients had multiple episodes of severe/Brown grade III anaphylaxis before presentation. As expected with WDEIA, all patients tolerated exercise/other cofactors and wheat independently, although they all reported rare, mild intermittent urticaria that was correlated with wheat ingestion and resolved with antihistamines. Predominant cardiovascular symptoms (including loss of consciousness) with minimal respiratory involvement was noted in all patients. The severity of the anaphylactic shock appeared consistent across all patients regardless of the intensity of exercise, and amongst the different cofactors including alcohol, nonsteroidal anti-inflammatory drugs, and menstruation. Exercise was the most common cofactor in 7 of 7 patients. No correlation of omega-5 gliadin, wheat,…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 7 participants or records.
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