Food-Dependent Exercise Anaphylaxis — SCE Dermatology MCQ

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HardInflammatory DermatosesFood-Dependent Exercise AnaphylaxisSCE Dermatology

A 28-year-old woman presents with recurrent anaphylaxis triggered by exercise following a meal. She has wheat-specific IgE. Skin prick testing to wheat is positive. She is asymptomatic at rest and after eating wheat without subsequent exercise. What is the diagnosis?

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Correct answer: B — Wheat-dependent exercise-induced anaphylaxis (WDEIA)

Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a form of food-dependent exercise-induced anaphylaxis where symptoms (urticaria, angioedema, anaphylaxis) occur only when exercise follows ingestion of the trigger food (wheat in this case). Neither wheat ingestion alone nor exercise alone triggers symptoms. The sensitising allergen is omega-5 gliadin (a wheat protein). Specific IgE to omega-5 gliadin is the diagnostic test. Management: avoid exercise for 4-6 hours after eating wheat, carry an Adrenaline auto-injector, and consider avoiding wheat entirely before planned exercise. This condition is increasingly recognised in young adults and is distinct from coeliac disease and standard wheat allergy.

Reference: BSACI Anaphylaxis Guidelines; BAD