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Curr Allergy Asthma Rep (2013) 13:639644
DOI 10.1007/s11882-013-0388-2
FOOD ALLERGY (D ATKINS, SECTION EDITOR)
Food-Dependent Exercise-Induced Anaphylaxis: Is Wheat Unique?
Gabriel K. Wong & Mamidipudi T. Krishna
Published online: 15 October 2013# Springer Science+Business Media New York 2013
Abstract This review draws comparisons between wheat-dependent exercise-induced anaphylaxis (WDEIA) and other food-dependent exercise-induced anaphylaxis (FDEIAs) and discusses the importance of co-factors in its pathophysiology. FDEIA remains an enigmatic condition since it was first described 30 years ago. The sporadic and unpredictable nature of its reactions has puzzled clinicians and scientists for decades, but recent studies on WDEIA have enlightened us about the pathophysiology of this condition. The identification of defined allergic epitopes such as Tri a 19, -gliadin, -gliadin and -gliadin in WDEIA enables it to become the perfect model for studying FDEIA, but WDEIA is by no means a unique condition. On a larger scale, FDEIA represents a crucial link between IgE-mediated and anaphylactoid reactions and provides supportive evidence for the concept of summation anaphylaxis and the need to overcome the allergen threshold. Future work should focus on identifying more of the FDEIA epitopes and understanding their distinct molecular properties. The development of a biomarker in order to identify patients susceptible to co-factor influences would be invaluable.
Keywords Food-dependent exercise-induced anaphylaxis . Wheat . Wheat-dependent exercise-induced anaphylaxis . Summation . Anaphylaxis . Omega-5-gliadin . Serum-specific IgE . Anaphylactoid reactions
Introduction
Food-dependent exercise-induced anaphylaxis (FDEIA) was first reported in 1979 by Maulitz et al. when a patients anaphylaxis was triggered by a combination of shellfish ingestion and exercise [1]. In the past 30 years, our understanding of this condition has improved, and a number of foods have now been associated with this clinical syndrome [2]. FDEIA is IgE-mediated; classical symptoms of type 1 hypersensitivity and serum-specific IgE (ssIgE) to culprit allergens are often detectable in patients [3]. Patients are usually able to tolerate exercise and ingestion of the offending food allergen independently as long as they are at least 45 h apart. The delayed onset of symptoms is unusual but can be seen in other IgE-mediated reactions such as tick bites and red meat allergy [4]. Although it was originally thought that the combination of food ingestion and exercise was crucial for a reaction to...