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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).
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 |
Table 2.
Differences between avoidance measures and recurrence rate of omega-5-gliadin allergy patients in Hong Kong (HK) and United Kingdom (UK)
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