Thongngarm Torpong, Wongsa Chamard, Pacharn Punchama, Piboonpocanun Surapon, Sompornrattanaphan Mongkhon
Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Allergy and Clinical Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Asthma Allergy. 2020 Sep 23;13:355-368. doi: 10.2147/JAA.S271429. eCollection 2020.
IgE-mediated wheat allergy in adults can be childhood or adulthood onset. Adult-onset wheat allergy has been reported, but data on clinical characteristics and practical food challenge protocols are scarce.
We aimed to describe the clinical characteristics of adult-onset wheat allergy, laboratory results, and outcomes of a modified 3-day challenge protocol using a combination of aspirin, wheat, and exercise.
Patients with histories compatible with adult-onset wheat allergy were recruited from Siriraj Hospital, Thailand. Clinical history, skin prick tests (SPTs), and specific IgE (sIgE) levels were ascertained. Patients with no food challenge contraindications were asked to volunteer for wheat challenge. A modified 3-day protocol using 300 mg of acetylsalicylic acid, 60-75 g of wheat flour, and exercise was used for confirmatory diagnosis of conventional wheat allergy (WA) and wheat-dependent exercise-induced anaphylaxis (WDEIA).
Thirty-three patients were recruited. The mean age of onset was 29.7 years (SD 10.5). SPTs yielded positivity rates of 9.1%, 84.8%, and 81.8% in commercial wheat, in-house gliadin, and in-house glutenin extracts, respectively. sIgE yielded a positivity rate of 61% and 88% in wheat and ω5-gliadin, respectively. Eighteen patients underwent oral wheat challenges. Of these, 17 patients (94.4%) had positive challenges leading to definite diagnoses of WA (35%), and WDEIA (65%). One WDEIA patient developed hypotensive anaphylaxis in the protocol.
WDEIA was the most common phenotype. Our modified 3-day protocol could differentiate WA and WDEIA and yielded a high positivity rate (94.4%). It should be used cautiously as severe reactions can occur.
成人IgE介导的小麦过敏可在儿童期或成年期发病。成人起病的小麦过敏已有报道，但关于临床特征和实际食物激发试验方案的数据较少。
我们旨在描述成人起病的小麦过敏的临床特征、实验室检查结果，以及使用阿司匹林、小麦和运动相结合的改良3天激发试验方案的结果。
从泰国诗里拉吉医院招募有成人起病小麦过敏病史的患者。确定临床病史、皮肤点刺试验（SPT）和特异性IgE（sIgE）水平。没有食物激发试验禁忌证的患者被邀请自愿参加小麦激发试验。采用改良的3天方案，使用300毫克乙酰水杨酸、60 - 75克小麦粉和运动来确诊传统小麦过敏（WA）和小麦依赖运动诱发的过敏反应（WDEIA）。
共招募了33名患者。平均发病年龄为29.7岁（标准差10.5）。在市售小麦、自制麦醇溶蛋白和自制麦谷蛋白提取物中，SPT的阳性率分别为9.1%、84.8%和81.8%。sIgE在小麦和ω5 - 麦醇溶蛋白中的阳性率分别为61%和88%。十八名患者接受了口服小麦激发试验。其中，17名患者（94.4%）激发试验呈阳性，确诊为WA（35%）和WDEIA（65%）。一名WDEIA患者在试验方案中发生了低血压性过敏反应。
WDEIA是最常见的表型。我们改良的3天方案可以区分WA和WDEIA，且阳性率较高（94.4%）。由于可能发生严重反应，应谨慎使用。
