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Idiopathic anaphylaxis remains a challenging clinical concern.
In patients experiencing unexplained anaphylaxis or reactions following NSAID use, wheat allergy, influenced by augmentation factors, should be a key consideration.
Idiopathic anaphylaxis remains a challenging clinical concern. Hidden allergens may play a role in idiopathic anaphylaxis and in hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAID-HS). This retrospective study sought to identify hidden triggers for anaphylaxis of unknown cause and NSAID-HS using skin prick tests (SPT) for 13 allergens and allergen-specific immunoglobulin E (sIgE) testing for 12 allergens, and to explore the diagnostic utility of each tested allergen.
This study incorporated patients referred between 2018 and 2021 with suspected idiopathic anaphylaxis or NSAID-HS based on clinical history who underwent SPT and/or sIgE testing to IA panel allergens. The data collected included patient demographics, comorbidities, anaphylaxis history and symptoms, final diagnoses, baseline serum tryptase levels, total IgE levels, SPT and sIgE results, and challenge outcomes.
Among 134 patients (77 female, mean age 39.7 ± 14.6 years), the median baseline serum tryptase level was 4.23 μg/L, and the median total IgE level was 133.5 kU/L. Allergologic testing recognized positive sIgE results in 66 patients (60%) and positive SPT results in 61 patients (47%). Diagnostic workup, including challenges, confirmed or excluded allergies in 61 out of 134 patients (46%).
Gluten was the most common allergen identified by SPT (22.4%), while sIgE most frequently detected ω5-gliadin (21.6%). Both correlated with clinical history (SPT: r = 0.310; sIgE: r = 0.407). Challenges revealed occult food allergies in 28 patients (21%), with wheat allergy dependent on augmentation factors as the leading cause of anaphylaxis (19%).
Wheat allergy triggered by augmentation factors must be routinely considered in cases of unexplained anaphylaxis or reactions following NSAID intake.
The Journal of Allergy and Clinical Immunology
Test Panel of Hidden Allergens for "Idiopathic Anaphylaxis" Reveals Wheat Allergy Dependent on Augmentation Factors as Common Final Diagnosis
Nida Oztop et al.
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