Zubrinich Celia, Puy Robert, O'Hehir Robyn, Hew Mark
Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia.
School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
J Asthma Allergy. 2021 Apr 20;14:397-403. doi: 10.2147/JAA.S304444. eCollection 2021.
Allergy to the omega-5-gliadin component of gluten (O-5-G allergy) often manifests when wheat ingestion is followed by a co-factor, usually exercise. There is no established best approach to management.
We sought to identify the beneficial effects, firstly of establishing a firm diagnosis, and secondly of stringent management, either by avoiding gluten ingestion altogether or separating it temporally from exercise by at least 4 hours. We also determined how frequently patients adhered to their physicians' clinical recommendations.
We undertook a survey of individuals diagnosed with O-5-G allergy at our institution over 8 years, who had a consistent clinical history and confirmatory laboratory evidence.
Of 80 eligible individuals, 43 responded (54%). Symptoms began in adulthood for all bar one, and concurrent asthma and eczema was uncommon (9% prevalence, respectively). Median time to diagnosis was 2 years. Achieving a diagnosis reduced the rate of reactions (0.35 per month vs 1.085 reactions per month, p=0.029). Many patients (10/43) did not adhere to the recommended stringent approach, to either avoid wheat/gluten or separate food and exercise by 4 hours. However, those adopting a stringent approach had a substantially lower risk of recurrent allergic reaction (0.22 per month vs 0.74 per month, p=0.004).
The epidemiology of O-5-G allergy implies pathogenic mechanisms potentially distinct from those of childhood-onset food allergy. Accurate diagnosis improves the clinical trajectory, primarily through the adoption of a stringent management approach.
对面筋中ω-5-麦醇溶蛋白成分过敏（O-5-G过敏）通常在摄入小麦后伴随一种辅助因素（通常是运动）时出现。目前尚无既定的最佳管理方法。
我们试图确定，首先明确诊断的有益效果，其次是严格管理的有益效果，严格管理包括完全避免摄入面筋或使面筋摄入与运动在时间上间隔至少4小时。我们还确定了患者遵守医生临床建议的频率。
我们对在我们机构8年间被诊断为O-5-G过敏的个体进行了一项调查，这些个体有一致的临床病史和实验室确诊证据。
80名符合条件的个体中，43人回复（54%）。除一人外，所有患者的症状均在成年期开始，同时患有哮喘和湿疹的情况并不常见（患病率分别为9%）。诊断的中位时间为2年。确诊降低了反应发生率（每月0.35次反应 vs 每月1.085次反应，p = 0.029）。许多患者（10/43）未遵守推荐的严格方法，即避免食用小麦/面筋或使食物与运动间隔4小时。然而，采取严格方法的患者复发性过敏反应的风险显著较低（每月0.22次反应 vs 每月0.74次反应，p = 0.004）。
O-5-G过敏的流行病学表明其致病机制可能与儿童期食物过敏不同。准确诊断可改善临床进程，主要是通过采取严格的管理方法。
