Food-Dependent Exercise-Induced Anaphylaxis: Is Wheat Unique?
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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, α-gliadin, β-gliadin and γ-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.
KeywordsFood-dependent exercise-induced anaphylaxis Wheat Wheat-dependent exercise-induced anaphylaxis Summation Anaphylaxis Omega-5-gliadin Serum-specific IgE Anaphylactoid reactions
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Conflict of Interest
Mamidipudi T. Krishna has received grant support/honorarium from ALK Abello, Allergy Therapeutics, Meda Pharmaceuticals and Phadia; has received publishing royalties from Nova Biomedical; and is lead for national audits and member of the Standards of Care Committee for the British Society for Allergy and Clinical Immunology.
Gabriel K. Wong declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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