Food and Drug Reactions and AnaphylaxisTransglutaminase-mediated cross-linking of a peptic fraction of ω-5 gliadin enhances IgE reactivity in wheat-dependent, exercise-induced anaphylaxis☆,☆☆
Section snippets
Patients
Twenty patients with WDEIA (7 female and 13 male patients; mean age, 43 years; range, 25-70 years) took part in the study. All patients had convincing clinical histories of FDEIA after ingestion of wheat products and positive skin prick test reactions to wheat (1:10 wt/vol 0.9% NaCl), gliadin (1 mg/mL in 20% ethanol; crude, Sigma Chemical Co, St Louis, Mo), and purified ω-5 gliadin (50 μg/mL in 20% ethanol-PBS) prepared as previously described.3 ω-5 Gliadin-specific IgE levels ranged from 0.1
tTG treatment of digested ω-5 gliadin forms high-molecular-weight complexes showing strong IgE binding in immunoblotting
In immunoblotting pooled sera from 10 patients with WDEIA showed clear IgE binding to the peptides derived from pepsin digestion of ω-5 gliadin (Fig 1).
Discussion
We show that the IgE-binding ability of ω-5 gliadin, a major allergen in WDEIA, is retained after pepsin and trypsin digestion and that digested peptides are cross-linked by tTG into high-molecular-weight complexes. Cross-linking of a dominant peptic fraction of ω-5 gliadin considerably increases IgE binding both in vitro and in vivo in patients with WDEIA. We hypothesize that tTG activation during physical exercise could create large allergen complexes capable of eliciting anaphylactic
Acknowledgements
We thank Mrs Leena Petman for expert skin prick testing.
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2022, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Wheat was the most common culprit food reported across all patients with food-dependent exercise-induced allergic reactions. An increase in the activity of tissue transglutaminase and interleukin-6 was proposed as a component of the pathogenesis of wheat-dependent exercised-induced anaphylaxis (WDEIA) (Figure 3, B).61-64 Alternatively, another study reported a filaggrin gene mutation in a woman and her family members—all of whom had a history of WDEIA.
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2022, Clinics in DermatologyCitation Excerpt :Ingested gliadin peptides may have a higher likelihood of being bound to IgE in patients with WDEIA.53,55 In the literature, patients with WDEIA presented with hives or anaphylaxis related to exercise that progressed to chronic urticaria without a direct relationship to exercise.49–52 Oral challenge tests to wheat were positive and symptoms improved after an elimination diet.
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Supported by grants from the Finnish Cultural Foundation, the Helsinki University Hospital Research Fund, and the Finnish Society of Dermatology.
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Reprint requests: Kati Palosuo, MD, Laboratory of Immunotoxicology, Finnish Institute of Occupational Health, Topeliuksenkatu 41 b, 00250 Helsinki, Finland.