ABSTRACT
Remission of gastrointestinal and general symptoms after gluten withdrawal has been described in some non-celiac individuals for nearly 30 years. Only recently, efforts have been made to define this entity, now referred to as "non- celiac gluten sensitivity". It includes patients that clinically respond to gluten free diet without exhibiting allergic or autoimmune features to explain such response. Wheat allergy, celiac disease, irritable bowel syndrome and symptoms induced by high FODMAPs (Fermentable, Oligo-, Di-, Mono-saccharides And Polyols) consumption are the main differential diagnoses. The relationship with neuropsychiatric disorders such as schizophrenia and autism has not been demonstrated, but currently it gives ground to great hope in families with affected children. Epidemiology of non-celiac gluten sensitivity is not clear. It is described as more common among women and less common in children. Genetic and immune factors, changes in intestinal microbiota and non-gluten components present in wheat grains are main factors postulated in the pathogenesis of this condition. To date, there are no specific biomarkers for non-celiac gluten sensitivity and diagnosis is reached by excluding other causes of disease. A trial with gluten-free diet and subsequent gluten challenge is the methodology most frequently used to confirm diagnosis.
Subject(s)
Humans , Food Hypersensitivity/diagnosis , Glutens/adverse effects , Autistic Disorder/etiology , Autistic Disorder/psychology , Celiac Disease/diagnosis , Celiac Disease/physiopathology , Diagnosis, Differential , Diet, Gluten-Free/methods , Food Hypersensitivity/complications , Food Hypersensitivity/diet therapy , Food Hypersensitivity/physiopathology , Irritable Bowel Syndrome/diagnosis , Irritable Bowel Syndrome/physiopathology , Schizophrenia , Wheat Hypersensitivity/complicationsABSTRACT
A forty-year-old military personnel presented with generalized urticaria, syncope, shortness of breath and headache associated with jogging after ingestion of a taro-filled bun and a red bean-filled bun. Skin prick test was positive for bread, taro and wheat but negative for red bean and preservative. Exercise challenge tests were performed. Exercise alone failed to induce any allergic reaction but exercise following ingestion of a taro-filled bun and a red bean-filled bun induced generalized urticaria. Since the patients stopped taking these types of food, the urticaria has not returned. This is the first case report of food-dependent, exercise-induced anaphylaxis in Thailand.