Omalizumab in the treatment of wheat-dependent exercise-induced anaphylaxis: case report

Abstract

Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a rare but possibly fatal condition. Patients with WDEIA may have severe difficulty for controlling their symptoms as the level of exercise, that can potentially trigger an anaphylaxis, may be very low. We, herein, report two patients with severe chronic spontaneous urticaria who subsequently developed WDEIA. Their symptoms occurred within minutes of walking at a slow pace after eating wheat-containing meals. Diagnosis were confirmed by positive omega-5 gliadin, gluten and wheat flour-specific IgE results. They have received omalizumab mainly for controlling their urticaria-related symptoms, but significant benefit has been obtained in regards to their exercise tolerance as well as their urticaria after the first injection of omalizumab. We have discussed the beneficial effects of omalizumab in these cases. However, additional clinical evidence would be needed for using omalizumab as a possible treatment option in WDEIA.