title: Eighteen cases of wheat allergy and wheat-dependent exercise-induced urticaria/anaphylaxis sensitized by hydrolyzed wheat protein in soap.
abstract: BACKGROUND
  Glupearl 19S, an acid-hydrolyzed wheat protein (HWP), is used widely in Japan as a moisturizing ingredient in facial soaps. Since 2010, there has been an increasing number of reports of contact urticaria and wheat allergy resulting from the use of products containing this substance.
  
  
  METHODS
  Sixty-one patients who had used HWP-containing facial soap visited our hospital. Thirty-five of these experienced urticaria or anaphylaxis after consuming wheat-containing food.
  
  
  RESULTS
  Eighteen of the 35 patients tested positive to 0.01% Glupearl 19S solution. Wheat-specific IgE and serum gluten-specific IgE were higher in the patients with HWP allergy than in non-HWP allergy patients. Among the patients who tested positive to Glupearl 19S on the skin prick test, nine experienced HWP-wheat-dependent exercise-induced anaphylaxis, and four experienced food-dependent anaphylaxis. Moreover, four of these patients not only experienced food-dependent anaphylaxis but also a worsening of the symptoms during exercise.
  
  
  CONCLUSIONS
  The clinical symptomology was so variable that the patients were classified into six groups. We found that patients with HWP allergy tended to manifest symptoms of both HWP-wheat-dependent exercise-induced anaphylaxis and contact urticaria. The etiology of hydrolyzed wheat protein allergy is unknown. Patients with a history of these symptoms need to be informed about the risk of consuming wheat-containing foods and the importance of excluding such items from their diet.
authors.affiliation: Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.affiliation: Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Kanzan
authors.initials: K
authors.lastname: Fuzishiro
authors.affiliation: Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Hirano
authors.affiliation: Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Okubo
authors.affiliation: Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Tsuboi
mesh_terms: D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000276:immunology*; D015444:Exercise; D005260:Female; D005983:Glutens / Q000276:immunology*; D006801:Humans; D006868:Hydrolysis; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000276:immunology*; D012882:Skin Tests; D012915:Soaps / Q000009:adverse effects* / Q000737:chemistry; D014908:Triticum / Q000276:immunology*; D014581:Urticaria / Q000276:immunology*; D021182:Wheat Hypersensitivity / Q000276:immunology*; D055815:Young Adult
chemical_list: C000606994:Glupearl 19S; D010455:Peptides; D012915:Soaps; D007073:Immunoglobulin E; D005983:Glutens