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首页> 外文期刊>The Journal of Allergy and Clinical Immunology >Using a gluten oral food challenge protocol to improve diagnosis of wheat-dependent exercise-induced anaphylaxis
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Using a gluten oral food challenge protocol to improve diagnosis of wheat-dependent exercise-induced anaphylaxis

机译：使用谷蛋白口服食物挑战方案来改善对小麦依赖性运动引起的过敏反应的诊断

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Background Oral wheat plus cofactors challenge tests in patients with wheat-dependent exercise-induced anaphylaxis (WDEIA) produce unreliable results. Objective We sought to confirm WDEIA diagnosis by using oral gluten flour plus cofactors challenge, to determine the amount of gluten required to elicit symptoms, and to correlate these results with plasma gliadin levels, gastrointestinal permeability, and allergologic parameters. Methods Sixteen of 34 patients with a history of WDEIA and ω5-gliadin IgE underwent prospective oral challenge tests with gluten with or without cofactors until objective symptoms developed. Gluten reaction threshold levels, plasma gliadin concentrations, gastrointestinal permeability, sensitivities and specificities for skin prick tests, and specific IgE levels were ascertained in patients and 38 control subjects. Results In 16 of 16 patients (8 female and 8 male patients; age, 23-76 years), WDEIA was confirmed by challenges with gluten alone (n = 4) or gluten plus cofactors (n = 12), including 4 patients with previous negative wheat challenge results. Higher gluten doses or acetylsalicylic acid (ASA) plus alcohol instead of physical exercise were cofactors in 2 retested patients. The cofactors ASA plus alcohol and exercise increased plasma gliadin levels (P <.03). Positive challenge results developed after a variable period of time at peak or when the plateau plasma gliadin level was attained. Positive plasma gliadin threshold levels differed by greater than 100-fold and ranged from 15 to 2111 pg/mL (median, 628 pg/mL). The clinical history, IgE gliadin level, and baseline gastrointestinal level were not predictive of the outcomes of the challenge tests. The challenge-confirmed sensitivity and specificity of gluten skin prick tests was 100% and 96%, respectively. Conclusion Oral challenge with gluten alone or along with ASA and alcohol is a sensitive and specific test for the diagnosis of WDEIA. Exercise is not an essential trigger for the onset of symptoms in patients with WDEIA.
机译：背景技术小麦依赖性运动引起的过敏反应（WDEIA）患者的口服小麦加辅因子挑战试验无法获得可靠的结果。目的我们试图通过口服面筋粉加辅因子攻击来确定WDEIA的诊断，确定引起症状所需的面筋量，并将这些结果与血浆麦醇溶蛋白水平，胃肠道通透性和变应性参数相关联。方法在34名有WDEIA和ω5-麦醇溶蛋白IgE病史的患者中，有16名接受了含或不含辅因子的面筋的前瞻性口服攻击试验，直至出现客观症状。确定了患者和38名对照受试者的面筋反应阈值水平，血浆麦醇溶蛋白浓度，胃肠道通透性，皮肤点刺试验的敏感性和特异性以及特定的IgE水平。结果在16例患者中的16例（女性8例，男性8例;年龄23-76岁）中，仅通过面筋（n = 4）或面筋加辅因子（n = 12）的攻击就证实了WDEIA，其中4例以前小麦挑战阴性结果。在2名接受重新测试的患者中，较高的麸质剂量或乙酰水杨酸（ASA）加酒精代替体育锻炼是辅助因素。辅助因子ASA加酒精和运动会增加血浆醇溶蛋白水平（P <.03）。在高峰期经过一段可变的时间或达到高原血浆醇溶蛋白水平后，就获得了积极的挑战结果。血浆麦醇溶蛋白阳性阈值水平相差100倍以上，范围为15至2111 pg / mL（中位数为628 pg / mL）。临床病史，IgE醇溶蛋白水平和胃肠道基线水平不能预测挑战试验的结果。挑战确认的面筋皮肤点刺试验的敏感性和特异性分别为100％和96％。结论单独使用麸质或与ASA和酒精一起口服挑战是诊断WDEIA的灵敏且特异的测试。运动并不是WDEIA患者症状发作的必要诱因。

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