Wheat allergy and Food dependent-exercise induced anaphylaxis - BSACI

Wheat allergy and Food dependent-exercise induced anaphylaxis

Wheat allergy commonly occurs in infancy and resolves in childhood. However, wheat can precipitate IgE-mediated food allergy in adults, most notably as a common trigger of food-dependent, exercise-induced anaphylaxis (FDEIA). Those affected are asymptomatic to the trigger food except when it is consumed in close proximity to exercise. The prevalence of FDEIA is unknown, although studies suggest that more than 80% of anaphylaxis cases involving exercise could be food related. Jogging is the most common exercise known to provoke FDEIA, but low-level exercise such as walking, or shopping can also generate a response. Although wheat is a common trigger food, shellfish, tomatoes, celery, peanuts, maize, soy, strawberries and cheese have all been reported to provoke FDEIA.

Co factor dependent food allergy

Cofactors may explain why in some cases food ingestion leads to anaphylaxis while in others it elicits a milder reaction or tolerance. With cofactors, reactions become more severe and/or have a lower eliciting dose of allergen. Exercise, NSAIDs, and alcohol are the most frequently described cofactors, although the underlying mechanisms are poorly understood. In other cases cofactors may be suspected but not identified.

Additionally, whilst wheat is the most commonly implicated allergen in cofactor dependent food allergy many other allergens have been identified as triggers. In particular, LTP allergy (add link to LTP allergy section) is associated with co-factor reactions, which makes management very difficult. The major foods involved include tree nuts, peanuts, apples and peaches but wheat can also be a cause of LTP-related co-factor dependent food allergy.  Sometimes more than one co-factor may be involved, and they can also be interchangeable.

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