Resolution of wheat-dependent exercise induced anaphylaxis-case report

Case report A 62 year old male was assessed in 2006 with a 3-4 year history of recurrent acute urticaria. A month prior to consultation he developed anaphylaxis. No consistent trigger was identified, therefore a covariable with food, such as exercise, was suspected. Skin prick testing (SPT) to foods ingested within 4 hours of anaphylaxis was positive to wheat flour and negative to wheat extract (WE) (Allergy Canada), peanut, egg, cow’s milk, cod, pickerel, salmon, whitefish, clam, and potato. Wheat products were tolerated daily, therefore WDEIA was suspected. Strict wheat avoidance was advised and epinephrine autoinjector prescribed. 4-6-12 months later he was asymptomatic with wheat avoidance. SPT was negative to oat, rye, corn flour. In 2008 and 2009 SPT was WE negative and flour positive. In 2010 he reported eating wheat products, followed by exercise, with no reactions >6 months. SPT was negative to WE and flour.