A innovative treatment for food-dependent exercise-induced anaphylaxis

Background: Food-dependent exercise-induced anaphylaxis (FDEIA) is characterized by development of systemic allergic reaction triggered when ingestion of food is followed by physical exercise. Wheat is one of the most common food triggers and generally symptoms occur until four hours after ingestion. The regular treatment in these cases is to avoid eating the implicated food 4 hours before exercise. We report a case of FDEIA trigged by wheat with a very low threshold, being triggered with minimal physical activities, which made not possible to use regular treatment and decreased patient quality of life, so we proposed a desensitization of wheat and physical exercise.

Methods: literature review and case report.

Results: A 19 years old male patient presented FDEIA trigged by wheat, characterized by hives, angioedema and respiratory symptoms after ingestion of small amount of wheat associated with minimal physical activities. He presented positive skin prick test for wheat and ω 5-gliadin high levels. Since the patient presented severe symptoms and a very low threshold we decided to submit him to a desensitization process of wheat and exercise at the same time during two weeks. We started offering the patient 0,025 mg of wheat followed by 1 minute of moderated physical exercise  performed in an exercise bike. We progressed the process maintaining the same dose of wheat and increasing physical exercise to 5 minutes and after to 10 minutes. In each step we first increased the dose of wheat intake and after we increased the time of exercise. In the end of the desensitization the patient was submitted to an open oral challenge with 150g of regular pasta (approximately 11,25g of wheat) followed by 30 minutes of moderate physical exercise. In each stage of the desensitization we collected serum of the patient to dose tryptase. The patient only presented hives in the process when he underwent to an open oral challenge with 300g of regular pasta (approximately 22,5g of wheat). The patient is eating a regular amount of wheat  everyday followed by physical exercise without complications. The dosage of tryptase was normal in every step, including the day the patient presented symptoms.

Conclusions: Food-dependent exercise-induced anaphylaxis caused by wheat ingestion might be treatable as presented in our case. This could improve the quality of life of many patients with the same problem. Tryptase presented not to be a very good marker in our case which was compatible with literature review for food allergies.