Journal List > Asia Pac Allergy > v.10(1) > 1148388

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

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.

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.
apa-10-e5f1.tif
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.
apa-10-e5f2.tif
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).
apa-10-e5f3.tif
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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