Resolution of wheat-dependent exercise induced anaphylaxis-case report

Background

The natural history of Wheat Dependent Exercise Induced Anaphylaxis (WDEIA) is not well defined. In IgE mediated, non exercise dependent, wheat allergy in children, the approximate age for resolution is 6.5 years with rare persistence into adolescence [1]. We report a case of resolution of WDEIA in an adult.

Case report

A 62 year old male was assessed in 2006 with a 3-4 year history of recurrent acute urticaria. A month prior to consultation he developed anaphylaxis.

No consistent trigger was identified, therefore a co-variable with food, such as exercise, was suspected.

Skin prick testing (SPT) to foods ingested within 4 hours of anaphylaxis was positive to wheat flour and negative to wheat extract (WE) (Allergy Canada), peanut, egg, cow’s milk, cod, pickerel, salmon, whitefish, clam, and potato. Wheat products were tolerated daily, therefore WDEIA was suspected. Strict wheat avoidance was advised and epinephrine autoinjector prescribed.

4-6-12 months later he was asymptomatic with wheat avoidance. SPT was negative to oat, rye, corn flour.

In 2008 and 2009 SPT was WE negative and flour positive.

In 2010 he reported eating wheat products, followed by exercise, with no reactions >6 months. SPT was negative to WE and flour.

Results

This patient demonstrates WDEIA which resolved four years after diagnosis. The patient is asymptomatic despite wheat ingestion followed by exercise. SPT to wheat flour, which was positive previously, is now negative.

Conclusion

This is the first case of WDEIA resolution reported. History plus SPT with wheat flour was used to diagnose WDEIA, and to confirm its resolution.