Department of Dermatology, Yokohama City University Medical Center, Yokohama, Japan.
Clin Exp Dermatol. 2010 Apr;35(3):233-7. doi: 10.1111/j.1365-2230.2009.03709.x. Epub 2009 Nov 19.
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to enhance the symptoms of wheat-dependent exercise-induced anaphylaxis (WDEIA). In contrast to many reports on WDEIA, there have been only a few reports of wheat-dependent aspirin-induced anaphylaxis not induced by the combination of wheat and exercise.
Two patients with wheat-dependent anaphylaxis underwent provocation tests to clarify the cause of their symptoms. Skin-prick testing (SPT) was also performed with and without administration of aspirin. Specific IgE antibody to wheat, gluten, and omega-5 gliadin were examined.
In the provocation tests, anaphylactic reactions were not induced by wheat or aspirin alone or by the combination of wheat and exercise, but were induced by the combination of wheat and aspirin. An increase in the blood histamine level was detected after provocation in both patients. Pretreatment with aspirin enhanced the SPT reactions to wheat and gluten in both patients. Specific IgE antibodies to wheat and gluten were expressed in the serum of both patients, and specific omega-5 gliadin IgE antibody was detected in the serum of one patient.
We present two cases of specific wheat-dependent anaphylaxis induced by aspirin but not by exercise. We suggest that pretreatment with aspirin under controlled conditions is useful to confirm the diagnosis of food allergy when a challenge test with food alone or with food and exercise fails to induce positive reactions.
阿司匹林和其他非甾体抗炎药（NSAIDs）已被报道可增强小麦依赖运动诱发过敏反应（WDEIA）的症状。与许多关于 WDEIA 的报道相反，仅有少数关于非运动性小麦依赖阿司匹林诱发过敏反应的报道，这些报道并未同时涉及小麦和运动。
两名小麦依赖过敏患者进行了激发试验以明确其症状的原因。还进行了有和无阿司匹林给药的皮肤点刺试验（SPT）。检查了针对小麦、谷蛋白和 omega-5 麦醇溶蛋白的特异性 IgE 抗体。
在激发试验中，单独的小麦或阿司匹林或小麦和运动的组合均未引起过敏反应，但小麦和阿司匹林的组合引起了过敏反应。在两名患者中，激发后均检测到血液组织胺水平升高。阿司匹林预处理增强了两名患者对小麦和谷蛋白的 SPT 反应。两名患者的血清中均表达了针对小麦和谷蛋白的特异性 IgE 抗体，一名患者的血清中检测到了针对特异性 omega-5 麦醇溶蛋白 IgE 抗体。
我们提出了两例由阿司匹林而非运动引起的特定小麦依赖过敏反应的病例。我们建议，在控制条件下使用阿司匹林预处理有助于在单独或与食物和运动一起进行食物挑战测试未能引起阳性反应时，确认食物过敏的诊断。
