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Grigori, 14 years from Russia
Where did this vehement reaction come from?
Contact with stinging insect
- Extensive medical history after the initial treatment reveals that an insect has stung him in the leg shortly before the match.
- He has reacted strongly to insect bites several times before. Therefore, the suspicion is obvious: bee and/or wasp venom allergy.
Consumption of wheat
- Grigori also says that he ate a stuffed sandwich after school and then rushed to the football tournament.
- A possible wheat allergy was considered unlikely, as the boy had never had problems with wheat-containing products before.
Allergen source
Allergen
Biochemical designation
IgE Level [kUA/L]
Timothy grass
Phl p 1
Beta-Expansin
27.37
American house dust mite
Der f 2
NPC2
26.13
European house dust mite
Der p 2
NPC2
30.26
Common wasp venom
Ves v 1
Phospholipase A1
0.41
Common wasp venom
Ves v 5
Antigen 5
13.29
Paper wasp
Pol d 5
Antigen 5
10.43
Wheat
Tri a 19
Omega-5-Gliadin
18.16
Rye
Sec c_pollen
Extract
15.15
Interpretation & summary
- Phl p 1 (Timothy grass) positivity confirms genuine grass pollen sensitisation, explaining Grigori’s long-standing rhinitis and seasonal symptoms
- Positive Ves v 1, Ves v 5 and Pol d 5 indicate clinically relevant Vespula venom sensitisation, consistent with the systemic reaction following the insect sting
- Tri a 19 (ω-5-gliadin) identifies wheat-dependent exercise-induced anaphylaxis (WDEIA) as the likely cause of his severe episode during physical exercise Summary
- Results of ALEX³® in conjunction with the medical history showed that Grigori suffers from wheat-depended exercise-induced anaphylaxis (wheat allergy triggered by physical exertion)
- He was also diagnosed with a clinically relevant wasp venom sensitisation
- Avoidance of wheat products to prevent anaphylactic shock is advised
- Avoidance of rye and barley is also advised due to a possible cross-reactivity between gluten proteins (gliadins and glutenins)
- He received an emergency kit containing an adrenaline autoinjector, a corticosteroid, and an antihistamine
Novel findings revealed by ALEX³
- Wheat-dependent exercise-induced anaphylaxis
- Wasp venom allergy
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