| Wheat dependent exercise induced anaphylaxis: is this an appropriate terminology? | |
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MedLine Citation:
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PMID: 20696684 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: The presentation of wheat dependent exercise induced anaphylaxis (WDEIA) can be variable. A high index of clinical suspicion is required to initiate the investigation pathway. Double blind placebo controlled food-exercise challenge is the gold standard investigation but the practicality of this test limits its application. AIM: To critically analyse the symptoms of WDEIA and their correlation with serum specific IgE (sIgE) to romega-5-gliadin. METHODS: 17 patients were tested for serum sIgE to romega-5-gliadin. The clinical response to a diet/exercise intervention protocol was used to assess specificity of a positive sIgE to romega-5-gliadin. Length of time to diagnosis, clinical likelihood scores, exercise intensity involved and the severity of allergic reactions were examined retrospectively. RESULT: 8/10 patients with positive sIgE to romega-5-gliadin had a confirmed diagnosis of WDEIA. Half of the WDEIA patients had a prolonged time lag to diagnosis (32-62 months) and were initially diagnosed with idiopathic anaphylaxis or chronic idiopathic urticaria and angioedema. Only three patients had experienced life threatening symptoms (Mueller grading 4). A close association was observed between requirements of lower exercise intensity to provoke a reaction and diagnostic delay. CONCLUSION: Specific IgE to romega-5-gliadin can provide supportive evidence for WDEIA without the need of a food-exercise challenge. The wheat-exercise association is not obvious in many patients, highlighting the need to consider WDEIA in the differential diagnosis of all patients presenting with idiopathic systemic reactions. The term anaphylaxis may be inappropriate and it is therefore worth considering an alternative terminology such as 'activity dependent wheat allergy' to describe this condition. |
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Authors:
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G K Y Wong; A P Huissoon; S Goddard; D M Collins; M T Krishna |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-08-09 |
Journal Detail:
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Title: Journal of clinical pathology Volume: 63 ISSN: 1472-4146 ISO Abbreviation: J. Clin. Pathol. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-09-07 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376601 Medline TA: J Clin Pathol Country: England |
Other Details:
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Languages: eng Pagination: 814-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Allergy and Clinical Immunology, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK. gabriel.wong@heartofengland.nhs.uk |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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