Exercise‐induced allergic reactions after achievement of desensitization to cow's milk and wheat

Abstract

Background We have previously reported that more than half of the patients who achieved desensitization after wheat rush oral immunotherapy (OIT) developed exercise‐induced allergic reaction on desensitization (EIARD). However, data on EIARDs after slow OIT are lacking. Therefore, this study aimed to investigate the results of exercise provocation tests (EPTs) in patients after slow OIT for cow's milk and wheat allergies. Methods This was a retrospective chart review of 87 EPTs in 74 patients. The EPTs were performed in patients who were desensitized to at least 6,600 mg cow's milk protein or 5,200 mg wheat protein with slow OIT and were identified to be at a high risk of EIARDs. EPTs were performed after ingestion of the maximum desensitization dose. The patients’ clinical characteristics and symptoms were analyzed. Results The EPT results were positive for cow's milk in 49% (21/43) of the patients and for wheat in 48% (15/31) of the patients. There was no significant difference in the clinical characteristics between the EIARD‐positive and EIARD‐negative groups. The specific IgE (sIgE) levels before OIT and the reduction rates of sIgE before and after OIT did not correlate with the outcomes of the EPTs. Among the EIARD‐positive patients, 13 patients (cow's milk, n = 7; wheat, n = 6) underwent a second EPT, and the EIARD disappeared in 8 patients (cow's milk, n = 4; wheat, n = 4). Conclusion EIARDs were observed after slow OIT for cow's milk and wheat. Further research into the predictive factors of EIARDs in these patients is needed to understand its clinical manifestations.

Changes in clinical features of food-related anaphylaxis in children during 5 years

“…In cases that already experienced food-induced allergic symptoms, FDEIA with strict definition has not been diagnosed even if exercise after food ingestion causes anaphylaxis. Kubota et al [ 10 ] reported that exercise-induced allergic reactions were observed after slow OIT for cow’s milk and wheat. Exercise-induced allergic symptoms in children with food allergies in this study should be called exercise-induced allergic reaction rather than FDEIA.…”

Novel Diagnostic and Immunotherapeutic Approaches for Wheat Allergy

“…A study evaluating the two-year follow-up prognosis for WA patients who achieved short-term SU after receiving wheat OIT revealed six out of eight symptomatic patients experienced adverse allergic reactions after exercise and three of them developed anaphylaxis [85]. Studies reported that EIARDs occurred not only after rush OIT but also after slow OIT for wheat, with 66.7% (14/21) and 48.4% (15/31) of WA patients developing EIARDs respectively [86,87]. Therefore, exercising after wheat intake may be the primary trigger for allergic symptoms during or after OIT.…”

A practical focus on wheat oral immunotherapy

“…Interestingly, among the patients who were positive for EIARD and who underwent a second EPT, the EIARD disappeared in four of six participants. 14 Also, a retrospective study conducted in Japan showed that, after WOIT, 25% of the subjects (6/24) had a positive EPT result; one subject required treatment with epinephrine. 15 Taken together, results of these studies suggest that consideration of an EPT before liberalizing exercise restrictions may be important for patients undergoing WOIT.…”