• anaphylaxis;
  • urticaria;
  • wheat allergy

Wheat allergy may present different clinical outcomes including food allergy, baker's asthma or food dependent exercise-induced anaphylaxis (FDEIA) (1). It mainly occurs after ingestion of wheat in childhood and may be lost after a period of strict avoidance (e.g., 1–2 years). By contrast, wheat allergy is rare in adults (2), by whom wheat dependent exercise-induced anaphylaxis is more often (3,4). The relevant allergens of wheat are heterogeneous. Wheat proteins are classified into three fractions according their solubility. These fractions include water-soluble albumins, salt-soluble globulins and ethanol-soluble prolamins (gliadins) and the insoluble glutenins (1). Palosuo et al. reported that gluten is the major allergen for IgE-mediated reaction to wheat (3).

Here we report on a patient (female, 48 years) with suspected food-allergy, who complained of urticaria, angioedema, dyspnea and finally unconsciousness after a restaurant meal (deer-roast with sauce). A second episode followed after ingestion of a convenience food product and finally after ingesting mulled wine in combination with wheatflour based pastries. The patient was skin prick tested (SPT) using the following allergens: grass-, birch- and mugwort pollen, cat epithelium, alternaria and house dust mites and the suspected food allergens including wheat flour, rye flour and gluten, in addition total IgE and specific IgE antibody levels were measured. Skin prick test was positive to birch pollen, wheatflour and gluten. Total serum IgE was 131,00 kU/l, IgE antibody levels were CAP-II (2,20 kU/l) for wheatflour, CAP-III (3,97 kU/l) for gluten and CAP-0 (<0,35 kU/l) for birchpollen and grasspollen. According these results wheat allergy was suspected as a cause of the anaphylactic reactions and the patient received advice to keep a wheat-free diet over 10 days. The diet was followed by a double-blind placebo-controlled food challenge (DBPCFC). The DBPCFC was negative with wheatflour (40 g), gluten (10 g) and food additives (5), given either separately or in combination with exercise (HF > 120/min) or ethanol (30 ml), respectively. Finally we challenged additiva, ethanol, wheatflour and exercise in combination Then a positive reaction (generalized urticaria) was elicited and antiallergic intervention was necessary (150 mg prednisolon and 4 mg fenistil i.v.) consecutively.

The present case demonstrates that many different factors may aggravate the elicitiation of an anaphylactic reaction in a wheat sensitive individual. Our observation is comparable to a case reported by Aihara Y et al. (6) in which a patient with FDEIA reacted only after the simultaneous intake of wheat and umeboshi. In a review of 163 cases of FDEIA, wheat was found to be the most frequently aggravating factor for FDEIA (4). Taken together this case demonstrates patients suffering from FDEIA need a detailed allergic work up including DBPCFC with several possible elicitating factors, such as food additives, ethanol and exercise.

Accepted for publication 2 July 2002 Allergy 2002: 57:1090–1091 Copyright © Blackwell Munksgaard 2002 ISSN 0105-4538


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  2. References
  • 1
    Varjonen E, Vainio E, Kalimo K. Antigliadin IgE- indicator of wheat allergy in atopic dermatitis. Allergy 2000;55:386391.
  • 2
    Kaukinen K, Turjanmaa K, Mäki M et al.Intolerance to cereals is not specific for coeliac disease. Scand J Gastroenterol 2000;35:942946.
  • 3
    Palosuo K, Alenius H, Varjonen E et al. A novel wheat gliadin as a cause of exercise-induced anaphylaxis. J Allergy Clin Immunol 1999;103:912917.
  • 4
    Steurich F, Feyerabend R. Nahrungsmittelbedingte anstrengungsinduzierte Anaphylaxie. Allergologie 2000;23:1928.
  • 5
    Worm M, Ehlers I, Sterry W, Zuberbier T. Clinical relevance of food additives in adult patients with atopic dermatitis. Clin Exp Allergy 2000;30:407414.
  • 6
    Aihara Y, Kotoyori T, Takahashi Y et al. The necessity for dual food intake to provoke food-dependent exercise-induced anaphylaxis (FEIAn): a case report of FEIAn with simultaneous intake of wheat and umeboshi. J Allergy Clin Immunol 2001;107:11001105.