Jiang et al reported criteria for the diagnosis of wheat-dependent, exercise-induced anaphylaxis (WDEIA) in China. The authors are from Peking Union Medical College Hospital and the Chinese Academy of Medical Sciences in Beijing.
(1) signs and symptoms of anaphylaxis(see below) during exercise ONLY if preceded by consumption of a wheat product
(2) onset when patient exercised <= 6 hours after eating a wheat product
(3) evidence of type I hypersensitivity to wheat - one of the following:
(3a) positive specific IgE to gluten, omega-5-gliadin, or wheat extract
(3b) positive skin test to gluten
(3c) positive skin test to gliadins
(4) successful avoidance of WDEIA when avoiding consumption of wheat products or when not exercising within 6 hours of eating a wheat product
(5) symptoms may be triggered at rest (not exercising) if exposed to an augmenting factor - NSAID, aspirin or alcohol
A patient can be diagnosed with WDEIA if both of the following are present:
(1) criteria 1, 2 and 3
(2) either or both of criteria 4 and 5
Signs and symptoms may be one or both of the following:
(1) acute onset of skin or mucosal involvement with generalized hives, pruritis, flushing and/or swelling of lips/tongue uvula AND one of the following:
(1a) respiratory compromise (dyspnea, wheezing, stridor, hypoxemia)
(1b) systemic findings with hypotension, syncope, incontinence or hypertonia
(2) >= 2 of the following
(2a) generalized hives, pruritis, flushing, swollen lips/tongue/uvula
(2b) respiratory compromise (dyspnea, wheezing, stridor, hypoxemia)
(2c) systemic findings with hypotension, syncope, incontinence or hypertonia
(2d) persistent GI symptoms (crampy abdominal pain, vomiting)
