A case of wheat-dependent exercise-induced anaphylaxis sensitized by a soap with a hydrolyzed wheat protein

Abstract

Since May 2009, a 45-year-old woman repeatedly developed swelling around her eyes during postprandial walks. She particularly noticed swelling of her face while walking after eating Tempura in April 2010 and developed anaphylaxis while walking after eating a muffin in July 2010. IgE-RAST was positive for wheat, gluten and ω5-gliadin. Provocation tests demonstrated that anaphylaxis developed when she took both aspirin and wheat together. She had begun using a soap containing hydrolyzed wheat protein two years earlier. Both a prick test and a patch test to a hydrolyzed wheat protein showed positive responses, suggesting that this patient had both an immediate-type and a delayed-type hypersensitivity reaction to hydrolyzed wheat protein. We assume that intake of wheat followed by exercise or aspirin intake provoked the wheat-dependent induced anaphylactic episodes via percutaneous sensitization to a hydrolyzed wheat protein.