| Summary: | Celia Zubrinich,1,2 Robert Puy,1,3 Robyn O’Hehir,1,3 Mark Hew1,2 1Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia; 2School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia; 3Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, Melbourne, Victoria, AustraliaCorrespondence: Celia Zubrinich Email c.zubrinich@alfred.org.auBackground: Allergy to the omega-5-gliadin component of gluten (O-5-G allergy) often manifests when wheat ingestion is followed by a co-factor, usually exercise. There is no established best approach to management.Objective: We sought to identify the beneficial effects, firstly of establishing a firm diagnosis, and secondly of stringent management, either by avoiding gluten ingestion altogether or separating it temporally from exercise by at least 4 hours. We also determined how frequently patients adhered to their physicians’ clinical recommendations.Methods: We undertook a survey of individuals diagnosed with O-5-G allergy at our institution over 8 years, who had a consistent clinical history and confirmatory laboratory evidence.Results: Of 80 eligible individuals, 43 responded (54%). Symptoms began in adulthood for all bar one, and concurrent asthma and eczema was uncommon (9% prevalence, respectively). Median time to diagnosis was 2 years. Achieving a diagnosis reduced the rate of reactions (0.35 per month vs 1.085 reactions per month, p=0.029). Many patients (10/43) did not adhere to the recommended stringent approach, to either avoid wheat/gluten or separate food and exercise by 4 hours. However, those adopting a stringent approach had a substantially lower risk of recurrent allergic reaction (0.22 per month vs 0.74 per month, p=0.004).Conclusion: The epidemiology of O-5-G allergy implies pathogenic mechanisms potentially distinct from those of childhood-onset food allergy. Accurate diagnosis improves the clinical trajectory, primarily through the adoption of a stringent management approach.Keywords: omega-5-gliadin allergy, wheat allergy, food allergy, anaphylaxis, wheat-dependent exercise-induced anaphylaxis, WDEIA, food-dependent exercise-induced anaphylaxis, FDEIA
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