小麦依赖-运动诱发荨麻疹患者的临床特征

目的分析小麦依赖-运动诱发荨麻疹(wheat-dependent exercise-induced urticaria,WDEIU)患者的临床特征,探讨其与小麦依赖-运动诱发严重过敏反应(wheat-dependent exercise-induced anaphylaxis,WDEIA)的关系。方法回顾性分析2008年5月至2019年8月在北京协和医院变态反应科诊断的9例WDEIU患者及同时期诊断的18例WDEIA患者的临床资料。结果9例WDEIU患者均以荨麻疹起病,平均发病年龄为(23.4±11.8)岁,从起病到明确诊断的中位时间为36个月。77.8%的患者面筋特异性IgE阳性,83.3%的患者ω-5醇溶蛋白特异性IgE阳性。18例WDEIA患者严重过敏反应的平均发病年龄为(42.9±12.2)岁,72.2%的患者(13/18)既往有荨麻疹病史,从荨麻疹起病到出现严重过敏反应的中位时间为7(1.5~47)年。WDEIU组患者的发病年龄明显低于WDEIA组(P=0.001),其血清面筋特异性IgE水平显著低于WDEIA组(0.55 kUA/L vs.1.34 kUA/L,P=0.014),WDEIU组患者的ω-5醇溶蛋白特异性IgE水平较低,但差异无统计学意义(4.2 kUA/L vs.9.09 kUA/L,P=0.069)。结论WDEIU是一种少见病,可能为WDEIA的早期表现,临床难以识别。诊断依靠病史、血清特异性IgE检测和/或皮肤点刺试验。提高临床医生对WDEIU的认识,有助于早期诊断及干预,从而预防严重过敏反应的发生。

Clinical characteristics of patients with wheat-dependent exercise-induced urticaria

Objective To analyze the clinical characteristics of wheat-dependent exercise-induced urticaria(WDEIU)and to explore the relationship between WDEIU and wheat-dependent exercise-induced anaphylaxis(WDEIA).Methods The clinical features and results of laboratory detections of 9 patients were analyzed retrospectively,who were diagnosed as WDEIU in Department of Allergy,Peking Union Medical College Hospital from May 2008 to August 2019.Meanwhile,18 patients with WDEIA were selected randomly as controls.Results There are 8 males and 1 female among nine WDEIU patients,whose mean age at onset was(23.4±11.8)years-old.The median time from onset to diagnosis was 36 months.The clinical manifestations included urticaria(9/9),laryngeal obstruction(3/9),and lip edema(1/9).Positive results of specific-IgE to wheat were shown among 55.6%(5/9)patients,while positive results of specific-IgE to gluten and ω-5 gliadin were 77.8%(7/9)and 83.3%(5/6)respectively.The mean age of onset of severe allergic reaction was(42.9±12.2)years-old in WDEIA group.72.2%(13/18)of them had history of urticaria,and the median time from onset of urticaria to anaphylaxis was 7(1.5-47)years.The age of onset was significantly lower in WDEIU group compared to WDEIA group(P=0.001),and serum gluten specific-IgE level was significantly lower than control group(0.55 kUA/L vs 1.34 kUA/L,P=0.014).ω-5 gliadin specific-IgE levels was lower in WDEIU group,but the difference was not significant statistically between two groups(P=0.069).Conclusions WDEIU is one kind of rare disease and difficult to be recognized,which may be the early stage of WDEIA.Diagnosis was based on medical history,serum specific IgE detection,and/or skin prick test.Improvement of understanding among clinicians helps to early diagnosis and intervention of WDEIU,which will be contributed to prevent severe allergic reactions.