Resolution of wheat-dependent exercise induced anaphylaxis-case report

BackgroundThe natural history of Wheat Dependent ExerciseInduced Anaphylaxis (WDEIA) is not well defined. InIgE mediated, non exercise dependent, wheat allergy inchildren, the approximate age for resolution is 6.5 yearswith rare persistence into adolescence [1]. We report acase of resolution of WDEIA in an adult.Case reportA 62 year old male was assessed in 2006 with a 3-4 yearhistory of recurrent acute urticaria. A month prior toconsultation 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 4hours of anaphylaxis was positive to wheat flour andnegative to wheat extract (WE) (Allergy Canada), pea-nut, egg, cow’s milk, cod, pickerel, salmon, whitefish,clam, and potato. Wheat products were tolerated daily,therefore WDEIA was suspected. Strict wheat avoidancewas advised and epinephrine autoinjector prescribed.4-6-12 months later he was asymptomatic with wheatavoidance. SPT was negative to oat, rye, corn flour.In 2008 and 2009 SPT was WE negative and flourpositive.In 2010 he reported eating wheat products, followedby exercise, with no reactions >6 months. SPT wasnegative to WE and flour.ResultsThis patient demonstrates WDEIA which resolved fouryears after diagnosis. The patient is asymptomatic despitewheat ingestion followed by exercise. SPT to wheat flour,which was positive previously, is now negative.ConclusionThis is the first case of WDEIA resolution reported.History plus SPT with wheat flour was used to diagnoseWDEIA, and to confirm its resolution.