Objective To assess the clinical value of different wheat-related protein allergens in the diagnosis of wheat-dependent exercise-induced anaphylaxis (WDEIA) and to improve the laboratory diagnostic method of WDEIA.

Methods 31 patients with suspected WDEIA were collected, and their medical history and clinical symptoms were statistically summarized. Wheat-associated protein-specific IgE antibodies were tested, and their sensitivity and specificity in the diagnosis of WDEIA were statistically analyzed.

Results All 31 patients had anaphylaxis during exercise, and 13 patients were allergic during follow-up and could be diagnosed as WDEIA. 20 patients had positive reactions to wheat-related protein-specific IgE testing, with the highest rate of positivity for 3-phosphoglyceraldehyde dehydrogenase (GAPDH), followed by ω-5 gliadin and wheat pollen extract. The sensitivity of these three proteins in the diagnostic analysis was 53.8%, 53.8%, and 23.1%, and the specificity was 66.7%, 88.3%, and 88.9%, respectively. ω-5 gliadin combined with wheat pollen extract had higher sensitivity (76.9%) and specificity (72.2%).

Conclusions WDEIA is a rare and severe allergic disease with facial edema, generalized rash, dyspnea, abdominal pain and diarrhea, cold sweats and syncope as the main manifestations. Clinical history and follow-up are essential for the diagnosis of WDEIA, and wheat-related protein-specific IgE assay also provides an important reference for the diagnosis of WDEIA, with the combination of ω-5 alcoholic protein and wheat pollen extract having the highest diagnostic value.