Using a gluten oral food challenge protocol to improve diagnosis of wheat-dependent exercise-induced anaphylaxis Knut Brockow, MD, Daniel Kneissl, Luzia.

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Presentation transcript:

Using a gluten oral food challenge protocol to improve diagnosis of wheat-dependent exercise-induced anaphylaxis Knut Brockow, MD, Daniel Kneissl, Luzia Valentini, PhD, Otto Zelger, MD, Martine Grosber, MD, Claudia Kugler, Martina Werich, Ulf Darsow, MD, Hiroaki Matsuo, PhD, Eishin Morita, MD, PhD, Johannes Ring, MD Journal of Allergy and Clinical Immunology Volume 135, Issue 4, Pages 977-984.e4 (April 2015) DOI: 10.1016/j.jaci.2014.08.024 Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Patient recruitment and challenge results of the study. Journal of Allergy and Clinical Immunology 2015 135, 977-984.e4DOI: (10.1016/j.jaci.2014.08.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Initial study protocol. After overnight fasting, the triple-sugar test (TST) was done before gluten challenge, and urine was collected for 5 hours. SPTs were performed to compare responses with and without premedication with ASA and alcohol (ASA/AL). Submaximal exercise intensity was determined and applied in further tests. Journal of Allergy and Clinical Immunology 2015 135, 977-984.e4DOI: (10.1016/j.jaci.2014.08.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Threshold levels for objective symptoms. Shown is the cumulative percentage of positive challenge results with gluten alone, gluten plus ASA and alcohol, and gluten plus submaximal exercise according to the amount of gluten used for challenge. Journal of Allergy and Clinical Immunology 2015 135, 977-984.e4DOI: (10.1016/j.jaci.2014.08.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Plasma gliadin levels during challenges, with clinical thresholds indicated. Gliadin levels reached a peak at reactions to 10 g of gluten (A) or to gluten plus cofactors (B) or were very near peak levels when clinical reactions occurred (C). Journal of Allergy and Clinical Immunology 2015 135, 977-984.e4DOI: (10.1016/j.jaci.2014.08.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Plasma gliadin levels in patients 4 (A), 5 (B), and 8 (C) with multiple positive reactions. ASA/AL, ASA and alcohol. Journal of Allergy and Clinical Immunology 2015 135, 977-984.e4DOI: (10.1016/j.jaci.2014.08.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 A and B, Intestinal permeability index (Fig E1, A) and gastroduodenal permeability (Fig E1, B) are lower a half hour after ingestion of 10 to 20 g of gluten in 4 patients and 3 control subjects. C and D, Intestinal permeability index (Fig E1, C) and gastroduodenal permeability (Fig E1, D) values increased after gluten plus the cofactors ASA and alcohol, leading to positive challenge results compared with gluten ingestion without a reaction. E and F, After physical exercise, intestinal permeability index (Fig E1, E) and gastroduodenal permeability (Fig E1, F) values increased in all 4 healthy control subjects. Journal of Allergy and Clinical Immunology 2015 135, 977-984.e4DOI: (10.1016/j.jaci.2014.08.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions