D2.55 - Food-Dependent Exercise-Induced Anaphylaxis: Prevalence of Wheat as an Allergen Compared to Other Foods

Food-Dependent Exercise-Induced Anaphylaxis (FDEIA) is a form of food allergy, where a reaction first appears in conjunction with exercise or other cofactor. Because of the specific conditions for an elicited reaction, FDEIA can be challenging to diagnose. Wheat is the most common allergen. The objective of this paper was to determine the incidence of different culprit foods for FDEIA at the Allergy Center in Aarhus, Denmark.

In this single-center retrospective cohort study, 101 patients (age 18-84, mean 40) being followed or investigated for FDEIA between 2020 and 2024 were identified. Culprit food and the results of diagnostic modalities were recorded and evaluated. Results were assessed in different four scopes, according to the confidence in diagnosis.

25 patients diagnosed with FDEIA were identified. Of these, 13 patients had FDEIA confirmed through an exercise-food challenge (EC). 12/13 (92%) had wheat as their culprit food, one (7%) had poultry. Of the 25 patients who were diagnosed with FDEIA, The culprit food prevalence was: 22 (88%) wheat, one (4%) poultry, one (4%) celery and nuts, one (4%) edamame beans, pumpkin seeds and sesame. From the patients, who were under investigation for FDEIA, but had not yet received a final diagnosis, 42/56 (75%) had wheat as a culprit food, and the remaining 14 patients had other suspected culprit foods.

The prevalence of wheat as a culprit food was 92% in EC-verified FDEIA and 88% in  patients with clinically diagnosed FDEIA. Negative food IgE, including omega-5-gliadin, and negative skin-prick tests were predictive of not having FDEIA. An oral food challenge added knowledge about a patient's diagnosis, but the outcome was not useful in predicting FDEIA. EC tests were highly predictive of FDEIA, but a negative result did not rule out the diagnosis.