I g E detection to α/β/γ‐gliadin and its clinical relevance in wheat‐dependent exercise‐induced anaphylaxis

Wheat‐dependent exercise‐induced anaphylaxis ( WDEIA ) is characterized by anaphylactic reactions after wheat ingestion and physical exercise. I g E antibodies to recombinant ω 5 ‐gliadin are detectable in a majority of WDEIA patients, but other wheat allergens may also play a role in elicitation of WDEIA . Here, we performed a comprehensive analysis of I g E reactivity to different wheat proteins in 17 patients with confirmed WDEIA by Immuno CAP research prototypes and a semi‐quantitative microarray immunoassay with α/β/γ‐gliadin, high‐molecular‐weight ( HMW ) glutenin, alpha‐amylase inhibitor ( AAI ) dimer, and wheat lipid transfer protein ( LTP ). By I mmuno CAP , I g E to recombinant ω 5 ‐gliadin was detectable in 14/17 patients (82%), to α/β/γ‐gliadin in 82% including the three patients lacking IgE to ω 5 ‐gliadin, and to HMW glutenin in 59%. The microarray revealed specifically γ‐gliadin as the second most important allergen. These results demonstrate the additional diagnostic value of α/β‐ and γ‐gliadin in particular in ω 5 ‐gliadin‐negative patients in the diagnosis of WDEIA .