rss
BMJ Case Reports 2012; doi:10.1136/bcr.01.2012.5641
  • Images in...

Wheat-dependent exercise-induced anaphylaxis associated with a facial soap

  1. Eiji Kusumi1,4
  1. 1Department of Internal Medicine, Navitas Clinic, Tachikawa, Japan
  2. 2Department of Hematology and Rheumatology, Teikyo Universiy Chiba Medical Center, Ichihara, Japan
  3. 3Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
  4. 4Division of Social Communication System for Advanced Clinical Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
  1. Correspondence to Dr Tetsuya Tanimoto, tetanimot{at}yahoo.co.jp

Description

A 27-year-old woman presented to our clinic with sudden-onset of nasal discharge and bilateral periorbital oedema (figures 1 and 2). Although she had been well until the morning, she noticed the extensive, rapidly progressing symptom during exercise at gymnasium after lunch containing fried-wheat. She had no history of food allergies. We performed a radioallergosorbent test, and it was positive for wheat. We made a diagnosis of so-called, wheat-dependent exercise-induced anaphylaxis (WDEIA).1 WDEIA is one of the most important clinical phenotypes of adult wheat allergy. Although most food-induced allergic reactions occur on first known oral exposure, WDEIA due to hydrolysed wheat protein (HWP), which can be used in cosmetics, shampoo, or hair conditioner, has been recently reported.2,,4 In Japan, a mail order soap, which sold 46.5 million bars to 4.6 million customers between 2004 and 2010, has caused at least 569 cases to suffer WDEIA. The development of their WDEIA could be induced by primary sensitisation to HWP in the facial soap and accompanying sensitisation to natural wheat protein. The causative allergen of the mass casualties was due to the HWP called Glupal-19S of the soap.4 We found her mother had the soap and confirmed the allergen in the present case by a skin-prick testing of Glupal-19S. She was treated with antihistaminergic agents, and her condition improved over the next several days. Her symptom has not recurred with prevention of exercise after meals, and she could take wheat-containing foods. Pathophysiology is not fully understood, but it is reported that cutaneous mast cells from patients with exercise-induced anaphylaxis presented morphologic changes similar to those observed in atopic patients following exercise.5 Clinicians should always expect the unexpected cause of allergen, and comprehensive history taking including a patient’s family is essential.

Figure 1

Bilarteral periorbital oedema.

Figure 2

A close-up picture of periorbital oedema.

Learning points

  • A comprehensive history taking including a patient’s family is essential to search for allergen.

  • WDEIA can be caused by an unexpected allergen, such as a soap containing a hydrolysed wheat protein. Patients with WDEIA may take wheat-containing foods unless they exercise.

Footnotes

  • Competing interests None.

  • Patient consent Obtained.

References

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article