Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
J Allergy Clin Immunol Pract. 2018 Nov-Dec;6(6):1892-1897. doi: 10.1016/j.jaip.2018.02.013. Epub 2018 Mar 1.
Omega-5 gliadin allergy (also known as wheat-dependent exercise-induced anaphylaxis) is a rare allergy to wheat that often presents with intermittent severe anaphylaxis in the context of a cofactor, such as exercise.
To undertake a detailed clinical characterization of the largest cohort of patients with omega-5 gliadin allergy to date.
We retrospectively analyzed the demographic characteristics, presentation, investigation, and management of 132 patients presenting with omega-5 gliadin allergy in 4 UK centers.
There were significant delays in diagnosis of 1 to 5 years (40% of patients) and more than 5 years (29% of patients). The commonest cofactors were exercise (80%), alcohol (25%), and nonsteroidal anti-inflammatory drugs (9%). A minority of patients (11%) had no identifiable cofactor. The level of specific IgE to omega-5 gliadin does not predict the severity of allergic reactions. Patients who adhered to a gluten-free diet and those who avoided wheat in combination with exercise achieved the largest reductions in subsequent allergic reactions of 67% and 69%, respectively.
Omega-5 gliadin allergy is a rare wheat allergy that presents with severe anaphylaxis. The diagnosis is frequently delayed, and therefore we recommend that all adult patients presenting with anaphylaxis of unclear cause should have omega-5 gliadin specific IgE tested. A gluten-free diet or avoidance of wheat-based meals in combination with exercise (if the cofactor is exercise) helps to significantly decrease the risk of future allergic reactions. However, antihistamines and an epinephrine autoinjector must always be prescribed because one-third of patients continue to have allergic reactions despite dietary advice.
ω-5 麦醇溶蛋白过敏（也称为小麦依赖运动诱发的过敏反应）是一种罕见的对小麦的过敏反应，通常在伴发如运动等协同因子的情况下间歇性出现严重过敏反应。
对迄今为止最大的一组ω-5 麦醇溶蛋白过敏患者进行详细的临床特征描述。
我们回顾性分析了 4 家英国中心就诊的 132 例ω-5 麦醇溶蛋白过敏患者的人口统计学特征、表现、检查和治疗情况。
诊断延误 1-5 年（40%的患者）和超过 5 年（29%的患者）的情况较为明显。最常见的协同因子是运动（80%）、酒精（25%）和非甾体抗炎药（9%）。少数患者（11%）没有可识别的协同因子。ω-5 麦醇溶蛋白特异性 IgE 水平并不能预测过敏反应的严重程度。坚持无麸质饮食和避免同时食用小麦和运动的患者，随后过敏反应的发生率分别降低了 67%和 69%。
ω-5 麦醇溶蛋白过敏是一种罕见的小麦过敏，表现为严重过敏反应。诊断常常被延误，因此我们建议所有出现不明原因过敏反应的成年患者都应进行ω-5 麦醇溶蛋白特异性 IgE 检测。无麸质饮食或避免食用含小麦的膳食并结合运动（如果协同因子是运动）有助于显著降低未来过敏反应的风险。然而，由于三分之一的患者尽管接受了饮食建议仍继续出现过敏反应，因此必须始终开具抗组胺药和肾上腺素自动注射器。
