Angiotensin-converting enzyme genotype is a risk factor for wheat-dependent exercise-induced anaphylaxis sensitized with hydrolyzed wheat protein

Dear Editor, In Japan, substantial interest has recently focused on wheat-dependent exercise-induced anaphylaxis (WDEIA) caused by percutaneous and/or rhino-conjunctival sensitization of hydrolyzed wheat protein (HWP), Glupearl 19S(R), which was used as ingredient of popular facial soap of which 46 million units had been sold. To date, more than 2000 people in Japan have been diagnosed with HWP-sensitized WDEIA (HWP-WDEIA). Apart from the sensitization pathway, patients with HWP-WDEIA manifest variable levels of immediate-type response following natural wheat product ingestion and exercise, which is quite similar to conventional WDEIA. Although some genetic factors may be responsible for the manifestation of WDEIA, its pathomechanism remains largely unknown. WDEIA is a rare disease in our country but we have encountered some patients with near-fatal anaphylactic reactions. Therefore this mechanism and genetic factors associated with the risk for WDEIA should be investigated. It has been reported that the angiotensin-converting enzyme (ACE) genotype was associated with cardiovascular, thrombotic and metabolic disorders.