Exercise‐induced allergic reactions on desensitization to wheat after rush oral immunotherapy

Background The effect of oral immunotherapy (OIT) on wheat allergy is promising in terms of the potential to obtain desensitization; however, the frequency of exercise‐induced allergic reactions on desensitization (EIARDs) and the associated risk factors remain to be determined. Methods Twenty‐five patients underwent rush OIT for wheat allergy, and 21 achieved the full‐dose intake of wheat products (5 g of wheat protein). Exercise‐provocation tests were repeatedly performed after the ingestion of a full‐dose wheat product. The time‐course of the levels of the specific IgEs (sIgE) to wheat extract, total gliadin, deamidated gliadin, recombinant gliadin components (α/β–, γ– and ω–5–), and glutenin (high and low molecular weight) components was analyzed using ImmunoCAP®, ELISA, or IgE immunoblotting. Results Fourteen patients (66.7%) were diagnosed as EIARD+, which remained 5 years after rush OIT in 11 patients (52.4%). There were no differences in the clinical backgrounds of the EIARD+ and EIARD− patients. However, EIARD+ patients showed significantly higher sIgE levels to all gliadin and glutenin components than EIARD‐ patients before OIT. The sIgE levels to each component decreased equally after 1 and 2 years of OIT. On IgE immunoblotting, sera from all patients reacted to the multiple gluten bands, and some reacted to the water‐soluble bands. The intensity of all IgE‐reactive bands also became equally lighter after OIT. Conclusions EIARDs were frequently observed and remained for a long period after successful OIT for wheat allergy. None of the specific wheat components were found to contribute to EIARDs. This study investigates the frequency and clinical features of children with EIARD remaining after oral immunotherapy (OIT). EIARD+ patients show significantly higher wheat components‐specific IgE levels compared to EIARD‐ patients before OIT. 52% patients remained EIARD+ 5 years after ROIT. Abbreviations: EIARD, exercise‐induced allergic reactions on desensitization; ROIT, rush oral immunotherapy