Differences in omega-5-gliadin allergy: East versus West

Philip Hei Li; Iason Thomas; Jane Chi-Yan Wong; Krzysztof Rutkowski; Chak-Sing Lau

doi:10.5415/apallergy.2020.10.e5

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Li, Thomas, Wong, Rutkowski, and Lau: Differences in omega-5-gliadin allergy: East versus West

Original Article

Asia Pac Allergy 2020;10(1):e5.

Published online: 4 January 2020

DOI: https://doi.org/10.5415/apallergy.2020.10.e5

Differences in omega-5-gliadin allergy: East versus West

Philip Hei Li^1,^*,^†, Iason Thomas^2,^†, Jane Chi-Yan Wong¹, Krzysztof Rutkowski², Chak-Sing Lau¹

¹Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong

²Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

^*Correspondence to Philip Hei Li Division of Rheumatology & Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong. Tel: +852-22553111 Fax: +852-2817 5496 E-mail: philipli@connect.hku.hk

^† These authors contributed equally to this work.

Received 9 December 2019 Accepted 23 January 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Omega-5-gliadin (O5G) allergy, also known as wheat-dependent exercise-induced anaphylaxis, is commonly reported in the Western, but not Asian, populations. Although significant differences in O5G allergy presentation across different populations are likely but there have been no previous reports on this important topic.

Objective

To report on the prevalence and characteristics of O5G allergy in Hong Kong (HK) compared with the United Kingdom (UK).

Methods

O5G allergy patients attending Queen Mary Hospital (HK cohort), and Guy's and St Thomas' Hospital, London (UK cohort) were studied and compared.

Results

A total of 46 O5G allergy patients (16 HK; 30 UK) were studied. In the HK cohort, 55% of all patients previously labeled as “idiopathic anaphylaxis” were diagnosed with O5G allergy. Exercise was the most common cofactor in both cohorts, followed by alcohol and nonsteroidal anti-inflammatory drugs (NSAID). A higher proportion of the HK cohort reported NSAID as a cofactor (13% vs. 0%, p = 0.048). In the HK cohort, more patients presented with urticaria and cardiovascular manifestations (100% vs. 77%, p = 0.036; 100% vs. 70%, p = 0.015, respectively); the range of presentation was more diverse in the UK cohort. In HK fewer patients adhered to wheat avoidance (50% vs. 87%, p = 0.007) and more patients avoided cofactors only (44% vs. 10%, p = 0.008).

Conclusion

O5G allergy appears relatively underdiagnosed in HK. Urticaria and cardiovascular manifestations are common; NSAID plays an important role as a cofactor and patients are less concordant with dietary avoidance measures than in the Western population.

Keywords: Allergy, Wheat, Cofactor, Food, Anaphylaxis

References

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Fig. 1.

Pie chart showing etiologies of previously labeled “idiopathic anaphylaxis” in Hong Kong (n = 29). ^* Out of 17/29 cases of wheat-related anaphylaxis, 16 were omega-5-gliadin allergy, and 1 was primary wheat allergy.

Fig. 2.

Venn diagram depicting the frequency and overlap of clinical symptoms during index reactions of omega-5-gliadin allergy patients in Hong Kong (n = 16). CVS, cardiovascular system.

Fig. 3.

Venn diagram depicting the frequency and overlap of clinical symptoms during index reactions of omega-5-gliadin allergy patients in United Kingdom (n = 30).

Table 1.

Association analysis of patient characteristics, cofactors, clinical manifestations and investigation results of omega-5-gliadin allergy patients in Hong Kong (HK) and United Kingdom (UK)

Characteristic	Combined (n = 46)	HK Cohort (n = 16)	UK Cohort (n = 30)	p value
Male sex	23 (50)	10 (63)	13 (43)	0.216
Age of onset (yr)	34 (16–69)	34 (16–69)	34 (17–69)	0.988
Chinese ethnicity	17 (37)	16 (100)	1 (3)	<0.001^*
Asthma or COPD	4 (9)	1 (6)	3 (10)	0.667
Other suspected food allergies	9 (20)	4 (25)	5 (17)	0.497
Chronic urticaria	18 (39)	6 (38)	12 (40)	0.869
Delay in diagnosis (yr)	2 (0–37)	5 (0–20)	1.5 (0–37)	0.837
Cofactors
Exercise	43 (94)	16 (100)	27 (90)	0.191
Alcohol	13 (28)	2 (13)	11 (37)	0.083
NSAID	2 (4)	2 (13)	0 (0)	0.048^*
Time between wheat ingestion and cofactor exposure (min)	30 (0–480)	17.5 (15–60)	60 (0–480)	0.079
Clinical manifestations
Urticaria	39 (85)	16 (100)	23 (77)	0.036^*
Angioedema	13 (28)	5 (31)	8 (27)	0.742
Respiratory manifestations	14 (30)	5 (31)	9 (30)	0.930
Gastrointestinal manifestations	5 (11)	3 (19)	1 (3)	0.077
Cardiovascular manifestations	37 (80)	16 (100)	21 (70)	0.015^*
Investigation results
Wheat SPT positivity	20 (63)^§	9 (82)^†	11 (55)^‡	0.135
Omega-5-gliadin sIgE (kU _A/L)	11.8 ± 1.65	12.61 ± 3.11	11.37 ± 1.95	0.738
Wheat sIgE (kU _A/L)	1.69 ± 0.63	1.14 ± 0.40	2.09 ± 1.05	0.682

Values are presented as number (%), median (range), or mean ± standard deviation.

COPD, chronic obstructive pulmonary disease; NSAID, nonsteroidal anti-inflammatory drug; SPT, skin prick test.

^* p < 0.05, statistically significant difference.

^† SPT was performed in 11/16 patients.

^‡ SPT was performed in 20/30 patients.

^§ SPT was performed in 31/46 patients.

Table 2.

Differences between avoidance measures and recurrence rate of omega-5-gliadin allergy patients in Hong Kong (HK) and United Kingdom (UK)

Variable	Combined (n = 46)	HK Cohort (n = 16)	UK Cohort (n = 30)	p value
Avoids wheat (and cofactors)	34 (74)	8 (50)	26 (87)	0.007
Only avoids cofactors	10 (22)	7 (44)	3 (10)	0.008
No avoidance	2 (4)	1 (6)	1 (3)	0.644

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