Magdalena Kraft1, Sabine Dölle-Bierke2, Jean-Marie Renaudin3, Franziska Ruëff4, Kathrin Scherer Hofmeier5, Regina Treudler6, Claudia Pföhler7, Thomas Hawranek8, Iwona Poziomkowska-Gęsicka9, Uta Jappe10, George Christoff11, Sabine Müller12, Montserrat Fernandez-Rivas13, Blanca E García14, Talía M De Vicente Jiménez15, Victoria Cardona16, Andreas Kleinheinz17, Burkhard Kreft18, Andrea Bauer19, Nicola Wagner20, Bettina Wedi21, Markus Wenzel22, Maria Beatrice Bilò23, Margitta Worm24. 1. Division of Allergy and Immunology, Dpt. of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Emergency Medicine, University Hospital Halle (Saale), Medical Faculty of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. 2. Division of Allergy and Immunology, Dpt. of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. 3. Presidency on behalf of Allergy Vigilance Network, Vandoeuvre les Nancy, France. 4. Department of Dermatology and Allergology, Klinikum der Universität München, Munich, Germany. 5. Division of Allergy, Department of Dermatology, University Hospital Basel, University of Basel, Basel, Switzerland. 6. Department of Dermatology, Venereology and Allergology and Leipzig Interdisciplinary Center of Allergology (LICA) Comprehensive Allergy Center, University Hospital, Leipzig, Germany. 7. Department of Dermatology, The Saarland University Medical Center, Homburg/Saar, Germany. 8. Department of Dermatology and Allergology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria. 9. Clinical Allergology Department, Pomeranian Medical University in Szczecin, Szczecin, Poland. 10. Division of Clinical and Molecular Allergology, Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research, Borstel, Germany; Interdisciplinary Allergy Outpatient Clinic, Dept. of Pneumology, University of Lübeck, Lübeck, Germany. 11. Faculty of Public Health, Medical University - Sofia, Sofia, Bulgaria; Allergy Out-patient Department, Acibadem CityClinic, Tokuda Medical Centre, Sofia, Bulgaria. 12. Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. 13. Department of Allergy, Hospital Clinico San Carlos, Universidad Complutense, IdISSC, ARADyAL, Madrid, Spain. 14. Allergology Service, Complejo Hospitalario de Navarra, Pamplona, Spain. 15. Allergy Department, Hospital Central de la Defensa Goméz-Ulla, Madrid, Spain. 16. Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain & ARADyAL research network, Spain. 17. Department of Dermatology, Elbe Medical Centre, Buxtehude, Germany. 18. Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. 19. Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany. 20. Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. 21. Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany. 22. Fachkrankenhaus Kloster Grafschaft, Schmallenberg, Germany. 23. Department of Clinical and Molecular Sciences, Marche Polytechnic University - Allergy Unit, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy. 24. Division of Allergy and Immunology, Dpt. of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. Electronic address: margitta.worm@charite.de.
Abstract
BACKGROUND: Wheat is one of the most commonly consumed foods and a known elicitor of anaphylaxis in children and adults. Reactions in adults are often cofactor dependent and characterized by a prolonged time between food intake and the onset of symptoms making the diagnosis of wheat anaphylaxis challenging. OBJECTIVE: To characterize a cohort of patients with the history of wheat anaphylaxis to better understand this atypical phenotype of anaphylaxis. METHODS: Data from the European Anaphylaxis Registry from 2007-2019 (n=10,636) including 250 patients (213 adults and 37 children) with a history of anaphylaxis caused by wheat were analyzed. RESULTS: Wheat was the most common food elicitor of anaphylaxis in adults in the registry in Central Europe. Reactions to wheat in adults were frequently associated with exercise as a cofactor (82.8%) and partially delayed (57.5%). Only 36.9% of patients had atopic comorbidities, which was uncommonly low for adult patients allergic to other kinds of food (63.2%). Anaphylaxis to wheat presented frequently with cardiovascular symptoms (86.7%) including severe symptoms such as loss of consciousness (41%) and less often with respiratory symptoms (53.6%). The reactions to wheat were more severe than reactions to other foods (OR=4.33), venom (OR=1.58), or drugs (OR=2.11). CONCLUSIONS: Wheat is a relevant elicitor of anaphylaxis in adults in Central Europe. Wheat anaphylaxis is highly dependent on the presence of cofactors and less frequently associated with atopic diseases compared with other food allergies. More data on mechanisms of wheat-induced anaphylaxis are required to develop preventive measures for this potentially life-threatening disease.
BACKGROUND: Wheat is one of the most commonly consumed foods and a known elicitor of anaphylaxis in children and adults. Reactions in adults are often cofactor dependent and characterized by a prolonged time between food intake and the onset of symptoms making the diagnosis of wheat anaphylaxis challenging. OBJECTIVE: To characterize a cohort of patients with the history of wheat anaphylaxis to better understand this atypical phenotype of anaphylaxis. METHODS: Data from the European Anaphylaxis Registry from 2007-2019 (n=10,636) including 250 patients (213 adults and 37 children) with a history of anaphylaxis caused by wheat were analyzed. RESULTS: Wheat was the most common food elicitor of anaphylaxis in adults in the registry in Central Europe. Reactions to wheat in adults were frequently associated with exercise as a cofactor (82.8%) and partially delayed (57.5%). Only 36.9% of patients had atopic comorbidities, which was uncommonly low for adult patientsallergic to other kinds of food (63.2%). Anaphylaxis to wheat presented frequently with cardiovascular symptoms (86.7%) including severe symptoms such as loss of consciousness (41%) and less often with respiratory symptoms (53.6%). The reactions to wheat were more severe than reactions to other foods (OR=4.33), venom (OR=1.58), or drugs (OR=2.11). CONCLUSIONS: Wheat is a relevant elicitor of anaphylaxis in adults in Central Europe. Wheat anaphylaxis is highly dependent on the presence of cofactors and less frequently associated with atopic diseases compared with other food allergies. More data on mechanisms of wheat-induced anaphylaxis are required to develop preventive measures for this potentially life-threatening disease.
Authors: Paul J Turner; Nandinee Patel; Barbara K Ballmer-Weber; Joe L Baumert; W Marty Blom; Simon Brooke-Taylor; Helen Brough; Dianne E Campbell; Hongbing Chen; R Sharon Chinthrajah; René W R Crevel; Anthony E J Dubois; Motohiro Ebisawa; Arnon Elizur; Jennifer D Gerdts; M Hazel Gowland; Geert F Houben; Jonathan O B Hourihane; André C Knulst; Sébastien La Vieille; María Cristina López; E N Clare Mills; Gustavo A Polenta; Natasha Purington; Maria Said; Hugh A Sampson; Sabine Schnadt; Eva Södergren; Stephen L Taylor; Benjamin C Remington Journal: J Allergy Clin Immunol Pract Date: 2021-08-23
Authors: Paul J Turner; Stefania Arasi; Barbara Ballmer-Weber; Alessia Baseggio Conrado; Antoine Deschildre; Jennifer Gerdts; Susanne Halken; Antonella Muraro; Nandinee Patel; Ronald Van Ree; Debra de Silva; Margitta Worm; Torsten Zuberbier; Graham Roberts Journal: Allergy Date: 2022-04-28 Impact factor: 14.710