Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Allergol Int. 2013 Sep;62(3):351-8. doi: 10.2332/allergolint.13-OA-0553. Epub 2013 Jul 25.
BACKGROUND: Recently, an increasing number of patients with wheat-dependent exercise-induced anaphylaxis (WDEIA) have been reported in Japan. Most of them had developed this condition during or after using hydrolyzed wheat protein (HWP)-containing soap (HWP-WDEIA). METHODS: To clarify the relation between WDEIA and HWP-containing soap and their prognosis, we retrospectively studied the patients who visited Hiroshima University Hospital and were diagnosed as WDEIA from January 2010 to June 2011. We took detailed clinical histories, performed skin prick tests, serum immunoassays for antigen-specific IgE and basophil histamine release test, and followed up their clinical courses after the diagnosis. RESULTS: Among 36 patients with WDEIA, 30 patients had used only one type of HWP-soap. The patients with HWP-WDEIA were mainly women and had developed facial symptoms and angioedema. They suffered from blood pressure reductions less frequently than patients with conventional WDEIA. The levels of gluten-specific IgE were higher than those of omega-5 gliadin in patients with HWP-WDEIA (P < 0.05, One-way ANOVA). All patients with HWP-WDEIA were positive against HWP in histamine release test. Among the conventional wheat antigens, glutenins induced the highest histamine release from basophils of patients with HWP-WDEIA. The sensitivities of patients against glutens and glutenins were reduced over months along with the discontinuance of HWP-soap. CONCLUSIONS: The development of HWP-WDEIA is associated with the use of HWP-soap. The sensitivity to HWP that cross reacts with non-processed wheat may be reduced or possibly cured after the discontinuation of HWP-soap.
背景:近来,在日本报告了越来越多的小麦依赖运动诱发过敏症(WDEIA)患者。他们大多数在使用含水解小麦蛋白(HWP)的肥皂(HWP-WDEIA)时或之后出现这种情况。
方法:为了阐明 WDEIA 与含 HWP 的肥皂之间的关系及其预后,我们回顾性研究了 2010 年 1 月至 2011 年 6 月期间到广岛大学医院就诊并被诊断为 WDEIA 的患者。我们详细询问了患者的临床病史,进行了皮肤点刺试验、血清抗原特异性 IgE 免疫测定和嗜碱性粒细胞组胺释放试验,并在诊断后对其临床过程进行了随访。
结果:在 36 例 WDEIA 患者中,有 30 例患者仅使用了一种 HWP 肥皂。HWP-WDEIA 患者主要为女性,出现面部症状和血管性水肿。与常规 WDEIA 患者相比,他们较少发生血压下降。HWP-WDEIA 患者的 gluten-specific IgE 水平高于 omega-5 麦醇溶蛋白(P < 0.05,One-way ANOVA)。所有 HWP-WDEIA 患者的组胺释放试验均对 HWP 呈阳性。在常规小麦抗原中,麦谷蛋白诱导 HWP-WDEIA 患者的嗜碱性粒细胞释放的组胺最高。随着 HWP 肥皂的停用,患者对谷朊和麦谷蛋白的敏感性在数月内降低。
结论:HWP-WDEIA 的发生与 HWP 肥皂的使用有关。与未经处理的小麦发生交叉反应的 HWP 敏感性可能在 HWP 肥皂停用后降低或可能治愈。
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