D1.174 - Does Wheat-Dependent Exercise-Induced Anaphylaxis Exist in Childhood? - Development and Application of a Diagnostic Protocol

Wheat is one of the most common grains, but also an important food allergen. Depending on age, wheat allergy presents quite differently. Adults mostly develop wheat-dependent exercise-induced anaphylaxis (WDEIA), where reactions occur after wheat consumption when triggered by physical activity. Otherwise, wheat is well tolerated. Children often develop wheat allergy in infancy and often outgrow it over time. However, the impact of physical exercise on wheat allergic reactions in children are less studied. One influencing factor might be the lack of an adapted challenge protocol to investigate WDEIA in childhood. The aim of this study was therefore to develop a standardized oral challenge protocol including physical activity and to investigate the impact of WDEIA in children.

Adult exercise protocols were adapted using age-appropriate exercises to standardize physical activity. Wheat-sensitized children and adolescents, without clinical reaction to age-appropriate serving sizes of wheat, were given high doses of 8g and 16g of wheat gluten. After each dose physical activity was performed aiming for 80% of the maximum level of physical effort, measured by pulse rate and Borg scale. 

31 participants with a median age of 10 years (4-17 years) were enrolled. 21 (67,7%) participants had outgrown their wheat allergy over time, while the others were sensitized since early childhood but clinically tolerant at the first oral food challenge. 94% (29/31) of the participants consumed the cumulative amount of 24g of wheat gluten. The other two refused to consume the amount entirely and were excluded. All participants reached the required level of physical effort by using bicycle ergometers and/or a trampoline, as age-appropriate. Regardless of the high amounts of wheat gluten in combination with physical exercise, none of the participants showed signs of an allergic reaction. 

The developed protocol for diagnosing WDEIA in children and adolescents proved to be feasible. However, we were not able to demonstrate that in wheat-sensitized children and adolescents, tolerating age-appropriate serving sizes, high amounts of gluten plus physical exercise elicit allergic reactions. This is in line with the much lower rate of reported WDEIA in childhood.

Funding: German Federal Ministry of Education and Research (BMBF), FKZ: 01EA2001A