Masked type I wheat allergy. Relation to exercise-induced anaphylaxis

Abstract

Six patients had type I hypersensitivity to wheat. Three cases were exercise-induced anaphylaxis to wheat, 1 was exercise-induced urticarial reaction to wheat (with angioedema) and the remaining 2 were exercise-accentuated urticarial reaction to wheat. Elimination of wheat from the diet completely cleared these symptoms. Allergens were prepared from wheat, gluten, gliadin and glutenin by simple extraction and enzyme digestion. These preparations were used in skin tests. The allergens obtained from gluten, gliadin and glutenin by pepsin digestion were qualitatively different from wheat and gluten allergens obtained by simple extraction and were more related to exercise-induced anaphylaxis. Trypsin digestion showed no such effect and abolished all these allergens. Wheat allergens are reinforced in the stomach and destroyed in the jejunum.