对 33 例成人小麦依赖性运动诱发过敏性休克(WDEIA)进行有效、安全的激发试验的结果

Akiko Sugiyama, Takehito Fukushima, Koki Okabe, K. Shimada, Kaoru Kojima, Yuko Shigeoka, Satoshi Honjo, Reiko Kishikawa
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引用次数: 0

摘要

背景:小麦依赖性运动诱发过敏性休克(WDEIA)不是由摄入小麦食品单独诱发的,而是由运动应激和摄入小麦食品共同诱发的。据报道,激发试验有助于诊断这种情况,但并不总是准确的。此外,激发试验与过敏性休克的风险有关,因此需要更安全的试验:本研究纳入了在 2019 年 4 月至 2023 年 7 月期间接受激发试验的 33 名患者(平均年龄为 35.5 ± 16.0 岁)。我们调查了他们的诱发试验结果与病史、诱发试验前的血液检测结果、试验时的运动负荷以及诱发症状的严重程度之间的关联:结果:28 例诱发症状并确诊为 WDEIA,2 例确诊为非 WDEIA。总体而言,在 28 例阳性病例中,有 25 例的运动负荷超过了按卡沃宁公式计算的心率的 70%,从而诱发了症状,其中 7 例需要服用非甾体抗炎药(NSAIDs)才能诱发症状。在小麦特异性 IgE 滴度阴性、麸质和/或ω-5 麦胶蛋白滴度阳性的患者中,没有人需要服用非甾体抗炎药。没有患者需要使用肾上腺素:结论:小麦特异性 IgE 以及麸质和ω-5 麦胶蛋白抗体滴度与 WDEIA 症状严重程度有关。运动负荷的目标心率为根据卡沃宁公式计算出的心率的 70%-90% 是安全的,而且有助于诊断这种疾病。
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Effective and safe provocation test for wheat-dependent exercise-induced anaphylaxis (WDEIA) in adults results of testing on 33 cases
Background: Wheat-dependent exercise-induced anaphylaxis (WDEIA) is induced not by the intake of wheat-based food alone, but by the combination of exercise stress and such intake. Provocation tests have been reported to be useful for the diagnosis of this condition, but they are not always accurate. Furthermore, provocation tests are associated with the risk of anaphylactic shock, so safer testing is required.Subjects and methods: Thirty-three patients (mean age 35.5 ± 16.0 years) who underwent provocation tests from April 2019 to July 2023 were included in this study. We investigated associations of their provocation test results with their medical history, blood test results before the provocation tests, exercise load at the time of the test, and severity of the induced symptoms.Results: Symptoms were induced and the diagnosis of WDEIA was made in 28 cases, while 2 cases were confirmed not to have WDEIA. Overall, 25 of the 28 positive cases had symptoms induced by an exercise load greater than 70% of the heart rate calculated by the Karvonen formula, 7 of which required Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) loading to induce symptoms. None of the patients with negative wheat-specific IgE titers and positive gluten and/or ω-5 gliadin ones required NSAIDs loading. No patients required the administration of adrenaline.Conclusion: Wheat-specific IgE as well as gluten and ω-5 gliadin antibody titers are associated with WDEIA symptom severity. Exercise loading with a target heart rate of 70%–90% of that calculated by the Karvonen formula is safe and useful for diagnosis this condition.
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