title: Wheat-dependent exercise-induced anaphylaxis: a retrospective case review from a tertiary hospital.
abstract: BACKGROUND
  Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a specific form of wheat allergy caused by the combination of wheat ingestion and physical exercise and has been reported in other parts of Asia. At present, there are no published reports of WDEIA in Singapore. The objective of this study is to characterise the common local clinical and laboratory manifestations of WDEIA.
  
  
  METHODS
  This was a retrospective descriptive study of all WDEIA who presented to a tertiary Singaporean Hospital over a 5-year-period from 1 January 2009 to 30 June 2013.
  
  
  RESULTS
  Eight patients aged 9-41 years old were characterised. Six were males and the majority (5) was of Chinese ethnicity. An atopic history was found in four patients. The symptoms of anaphylaxis included cutaneous manifestations such as urticaria (n=7), angioedema (n=6), respiratory symptoms of dyspnoea and wheezing (n=5) and hypotension (n=5). The symptoms occurred 20-75 min after consumption of wheat-based products, often upon cessation of exercise [running (n=3), walking (n=4) and swimming (n=1)]. The WDEIA was recurrent in seven patients. The skin prick tests were positive to wheat in seven patients, and ω-5 gliadin test to wheat was positive in five patients.
  
  
  CONCLUSIONS
  With the emergence of wheat allergy in East Asian countries, WDEIA has become an important condition for physicians and Singapore is no exception. Under-recognition combined with life-threatening symptoms warrants better public awareness measures. In addition, further studies are necessary to identify possible unique genetic and environmental exposures that could explain the inter-regional differences of WDEIA.
authors: University Children's Medical Institute, National University Hospital, Singapore, Singapore.
authors: Meera
authors: M
authors: Thalayasingam
authors: Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors: Nur Azizah
authors: NA
authors: Allameen
authors: University Children's Medical Institute, National University Hospital, Singapore, Singapore.
authors: Jian Yi
authors: JY
authors: Soh
authors: University Children's Medical Institute, National University Hospital, Singapore, Singapore Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
authors: Paul
authors: P
authors: Bigliardi
authors: University Children's Medical Institute, National University Hospital, Singapore, Singapore Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors: Hugo
authors: H
authors: Van Bever
authors: University Children's Medical Institute, National University Hospital, Singapore, Singapore Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors: Lynette Pei-Chi
authors: LP
authors: Shek
mesh_terms: D000707:Anaphylaxis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003937:Diagnosis, Differential; D037001:Directive Counseling; D015444:Exercise; D005260:Female; D005903:Gliadin / Q000009:adverse effects* / Q000494:pharmacology; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D012008:Recurrence; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D012882:Skin Tests; D062606:Tertiary Care Centers; D021182:Wheat Hypersensitivity / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D005903:Gliadin