Wheat‐dependent exercise‐induced anaphylaxis caused by percutaneous sensitisation to hydrolysed wheat protein in cosmetics

Abstract

In Japan, patients had developed anaphylaxis after percutaneous sensitization to hydrolysed wheat proteins (HWP) present in one specific facial soap (Glupearl).1, 2 We report the first patient with wheat-dependent exercise-induced anaphylaxis (WDEIA) after application of other HWP-containing cosmetics (HWP-WDEIA) in Europe. A 35-year-old female with atopic dermatitis developed facial swelling and contact wheals after applying a face mask or a shampoo, both containing hydrolysed wheat protein (HWP) (Figure S1; Figure 1A). Four months later, swelling of lips and face, generalized urticaria and diarrhoea arose after eating wheat noodles followed by fast walking. Symptoms recurred after eating noodles and exercise weeks later, but never by exercise alone. In allergy tests, skin prick tests were positive for wheat, HWP-containing own cosmetics (face mask, shampoo, Figure 1B) and HWP-Glupearl (provided by the manufacturer), but negative in three controls. Total IgE was 176 IU/ml, specific IgE (sIgE) for all wheat allergens including α-β-γ gliadin, r Tri a14 and ω-5 gliadin were negative. Ten minutes after successive challenge with (1) 20 ml ethanol, (2) intake of 64 g gluten and (3) aerobic treadmill exercise, generalized urticaria confirmed WDEIA (Figure 1C).3 The eczema was of moderate severity (SCORAD 12.5), transepidermal water loss was elevated (24.7) signifying skin barrier dysfunction. The sequence of (1) applying HWP cosmetics, (2) facial contact urticaria/angioedema and (3) WDEIA to wheat after a few weeks or months (Figure S1) indicate percutaneous sensitization to HWP with cross-reactivity to normal wheat and have so far only been described in Japanese patients after use of a specific HWP-containing soap. Specific IgE to all major allergens for WDEIA is negative in these patients with HWP-WDEIA, but skin tests to HWP products are positive.1 Our patient had atopic dermatitis and impaired skin barrier function predisposing to contact urticaria and percutaneous sensitization. Primary percutaneous sensitization against HWP and secondary cross-reactivity to unmodified wheat may also develop in Europe. Financial support was given by a research and development grant from the German Federal Ministry of Education and Research (BMBF) project ABROGATE (01EA2106A) as well as by the H.+W. Winkler Foundation ‘Hilfe für den Menschen’. Open Access funding enabled and organized by Projekt DEAL. The authors report no conflict of interest. Figure S1 Time course in the patient with wheat-dependent exercise-induced anaphylaxis sensitized to hydrolysed wheat protein Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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