Curr Treat Options Allergy (2017) 4:291–302
Anaphylaxis (M Sánchez-Borges, Section Editor)
Tomoyuki Asaumi, MD
Tetsuharu Manabe, MD
Noriyuki Yanagida, MD
Sakura Sato, MD
Motohiro Ebisawa, MD, PhD
Department of Pediatrics, Sagamihara National Hospital, 18-1, Sakuradai,
Minami-ku, Sagamihara-City, Kanagawa, 252-0392, Japan
Department of Allergy, Clinical Research Center for Allergy and Rheumatology,
Sagamihara National Hospital, Kanagawa, Japan
Published online: 1 June 2017
* Springer International Publishing AG 2017
This article is part of the Topical Collection on Anaphylaxis
Keywords Adrenaline auto injector
Hydrolyzed wheat protein
Wheat-dependent exercise-induced anaphylaxis (WDEIA) is presently gaining attention.
Patients with WDEIA experience allergic symptoms when they exercise following wheat
consumption. Some patients may be advised to restrict wheat consumption or exercise
because of repeated allergic symptoms without adequate diagnosis or examination.
Japanese guidelines recommend that WDEIA should be diagnosed using provocation tests
with wheat and exercise. After wheat consumption, patients exercise using a treadmill or
an ergometer during provocation tests. Once WDEIA is diagnosed, patients should not
consume wheat before physical activity. Exercise is allowed at least 4 h after wheat intake.
They may consume wheat if they do not exercise after wheat consumption, and they may
exercise without consuming wheat before exercising. All WDEIA patients should be
instructed regarding use of adrenaline auto-injector and should carry one with them.
Some patients may respond to prophylactic treatment with anti-histamines. However,
there is no established drug for preventing WDEIA; moreover, there is inadequate evidence
for routine administration of these prophylactic drugs. Cofactors like nonsteroidal anti-
inflammatory drugs (NSAIDs) may directly modulate immune reactions and could exacer-
bate the condition. Hence, patients should avoid these cofactors. The emergency treat-
ment of WDEIA does not differ from that of immediate-type food allergy or anaphylaxis.
Exercise should be stopped when patients show food allergy symptoms. When patients
show anaphylactic reactions, adrenaline should be quickly administered. Indications for
adrenaline auto-injector use are severe symptoms like persistent coughing, breathing with
wheeze, persistent abdominal pain, and confusion. However, there is no evidence that