A novel wheat gliadin as a cause of exercise-induced anaphylaxis
A novel wheat gliadin as a cause of exercise-induced anaphylaxis
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DOI：
10.1016/s0091-6749(99)70438-0
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发表时间：
1999-05-01
影响因子：
14.2
通讯作者：
Reunala, T
中科院分区：
文献类型：
--
作者：
Palosuo, K;Alenius, H;Reunala, T
背景资料：食物依赖性、运动引起的过敏反应是一种严重的过敏反应;该反应是由运动前摄入特定食物引起的。这种疾病往往逃避诊断，因为既不是摄入的食物，也不是运动单独诱导symptoms.Objective：这项研究的目的是描述过敏原参与小麦依赖性，运动诱导过敏反应，并描述了一系列的18名成人患者的临床结果。所有18例患者在运动期间均发生了全身性荨麻疹复发，17例患者与虚脱相关，15例患者与过敏反应相关。只有当患者在运动前吃了含有小麦的食物时才会出现症状。小麦过敏原检测免疫印迹，纯化凝胶过滤和反相色谱，并进行N-末端测序。通过ELISA研究纯化蛋白的IgE结合能力，并通过皮肤点刺试验研究其体内反应性。在免疫印迹中，来自合并的患者血清的IgE抗体与65-kd和40-kd小麦蛋白结合。65-kd过敏原是先前未描述的小麦蛋白，与γ-麦醇溶蛋白显示61%的序列同一性，而40-kd过敏原与α-麦醇溶蛋白具有100%的同一性。在ELISA中，所有18名患者对新的γ-样麦醇溶蛋白显示出升高的IgE水平，13名患者对α-麦醇溶蛋白显示出升高的IgE水平。54名对照受试者中没有一名患有小麦过敏、荨麻疹或乳糜泻的受试者具有针对γ-样麦醇溶蛋白的IgE抗体。γ-样麦醇溶蛋白的体内反应性通过在所有15名接受测试的患者中的阳性皮肤点刺试验反应来验证。在后续的无麸质或无小麦的饮食，3例患者经历的反应后，不知不觉地吃小麦运动前，但所有其他：坚持饮食的患者仍然是无菌free.Conclusion：这项研究表明，小麦是一个常见的原因，食物依赖性，运动引起的过敏反应，并表明，主要过敏原是一个以前未描述的γ-样麦醇溶蛋白。为了筛查这种危及生命的过敏，我建议用粗麦醇溶蛋白进行皮肤点刺试验，我们建议采用无麸质饮食进行治疗。
Background: Food-dependent, exercise-induced anaphylaxis is a severe form of allergy; the reaction is caused by ingestion of a specific food before exercise. This disorder often escapes diagnosis because neither the ingested food nor the exercise alone induces the symptoms.Objective: The aim of the study was to characterize the allergens involved in wheat-dependent, exercise-induced anaphylaxis and to describe the clinical outcome in a series of 18 adult patients.Methods: All 18 patients had experienced recurrent episodes of generalized urticaria during exercise, 17 patients in association with collapse and 15 patients with an anaphylactic reaction. The symptoms appeared only when the patients had eaten food containing wheat before exercise. Wheat allergens were detected by immunoblotting, purified by gel filtration and reversed-phase chromatography, and subjected to N-terminal sequencing. The IgE-binding ability of the purified proteins was studied by ELISA, and their in vivo reactivity was studied by skin prick testing.Results: IgE antibodies from pooled patient sera were bound to 65-kd and 40-kd wheat proteins in immunoblotting, The 65-kd allergen was a previously undescribed wheat protein, showing 61% sequence identity to gamma-gliadin, whereas the 40-kd allergen had 100% identity to alpha-gliadin, In ELISA, all 18 patients showed elevated IgE levels to the novel gamma-like gliadin, and 13 of the patients showed elevated IgE levels to the alpha-gliadin. None of the 54 control subjects with wheat allergy, urticaria, or coeliac disease had IgE antibodies to the gamma-like gliadin. The in vivo reactivity of the gamma-like gliadin was verified by positive skin prick test responses in all of the 15 patients who were tested. During the follow-up on a gluten-free or wheat-free diet, 3 patients experienced reactions after having unknowingly eaten wheat before exercise, but all the other : patients who were adhering to the diet remained symptom-free.Conclusion: This study shows that wheat is a frequent cause of food-dependent, exercise-induced anaphylaxis and suggests that the major allergen is a previously undescribed gamma-like gliadin. For screening of this life-threatening allergy, me recommend skin prick testing with crude gliadin and we recommend a gluten-free diet for treatment.