2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T6c4,The frequency of false negatives in exercise provocation tests (EPTs) when evaluating exercise-induced allergic reactions on desensitization (EIARD) remains unclear. This study aimed to determine the frequency of allergic symptom induction after a negative EPT result in patients at risk of EIARD and to identify its associated factors. This retrospective cohort study analyzed 109 patients aged 5-18 years who underwent EPTs between February 2012 and March 2023 to assess EIARD after wheat oral immunotherapy (OIT). EPT was performed in all cases after rush OIT and in high-risk cases after slow OIT. Patients with a negative/indeterminate EPT result were monitored for 1 year. Individuals who developed allergic reactions during exercise after wheat ingestion were categorized as "Event+" and were regarded as having false-negative EPT results. Patients without events were categorized as "Event-". Candidate factors between the Event+ and Event- groups were compared using nonparametric statistical tests. Among 53 patients with negative/indeterminate EPT results, 14 (26.4%) experienced allergic symptoms during follow-up (Event+ group). Higher ω5-gliadin-specific IgE levels at the time of EPT were significantly associated with Event+. No other factors (i.e., age, sex, allergy severity, or exercise intensity) showed any association. All Event+ cases occurred outdoors, suggesting a possible influence of environmental factors. False negatives occurred in 26.4% of pediatric wheat-desensitized patients with EPTs. Our findings highlight the need to periodically monitor EIARD after negative EPT results. Future studies should explore methods to improve the accuracy of EPTs and identify predictive markers of EIARD risk.31:T95c,Abstract Background The frequency of false negatives in exercise provocation tests (EPTs) when evaluating exercise‐induced allergic reactions on desensitization (EIARD) remains unclear. This study aimed to determine the frequency of allergic symptom induction after a negative EPT result in patients at risk of EIARD and to identify its associated factors. Methods This retrospective cohort study analyzed 109 patients aged 5–18 years who underwent EPTs between February 2012 and March 2023 to assess EIARD after wheat oral immunotherapy (OIT). EPT was performed in all cases after rush OIT and in high‐risk cases after slow OIT. Patients with a negative/indeterminate EPT result were monitored for 1 year. Individuals who developed allergic reactions during exercise after wheat ingestion were categorized as “Event+” and were regarded as having false‐negative EPT results. Patients without events were categorized as “Event−”. Candidate factors between the Event+ and Event− groups were compared using nonparametric statistical tests. Results Among 53 patients with negative/indeterminate EPT results, 14 (26.4%) experienced allergic symptoms during follow‐up (Event+ group). Higher ω5‐gliadin‐specific IgE levels at the time of EPT were significantly associated with Event+. No other factors (i.e., age, sex, allergy severity, or exercise intensity) showed any association. All Event+ cases occurred outdoors, suggesting a possible influence of environmental factors. Conclusion False negatives occurred in 26.4% of pediatric wheat‐desensitized patients with EPTs. Our findings highlight the need to periodically monitor EIARD after negative EPT results. Future studies should explore methods to improve the accuracy of EPTs and identify predictive markers of EIARD risk. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Wheat Allergy: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Wheat Allergy (condition). Clinician-written summaries and actionable practice insights. Updated daily.\",\"url\":\"https://www.reachrx.ai/hub/tag/condition/Wheat%20Allergy\",\"breadcrumb\":{\"@type\":\"BreadcrumbList\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https://www.reachrx.ai\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Research Hub\",\"item\":\"https://www.reachrx.ai/hub\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Conditions\",\"item\":\"https://www.reachrx.ai/hub/tag/condition\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Wheat Allergy\",\"item\":\"https://www.reachrx.ai/hub/tag/condition/Wheat%20Allergy\"}]}}"}}]],["$","$L2f",null,{"title":"Wheat Allergy: Research & Clinical Takeaways","description":"Discover peer-reviewed research on Wheat Allergy with concise clinician summaries and next-step guidance.","papers":[{"doi":"10.1111/cea.70429","pmid":"42725714","title":"High Specificity of\n sIgE\n to α−/β‐Gliadin and Limited Reactivity to Non‐Gluten Proteins in Wheat Allergy Dependent on Augmentation Factors (\n WALDA\n )","journal_title":"Clinical & Experimental Allergy","journal_issn":"0954-7894","published_at":"2026-09-11T00:00:00.000Z","url":"https://doi.org/10.1111/cea.70429","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-16T06:22:59.026Z","updated_at":"2026-09-16T06:22:59.026Z","tags":[{"paper_doi":"10.1111/cea.70429","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"condition","value":"Food-Dependent Exercise-Induced Anaphylaxis","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"condition","value":"Wheat Allergy","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"generic","value":"alpha-beta-gliadin sIgE (Tri a 21.0101)","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"generic","value":"omega-5-gliadin sIgE","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"modality","value":"Allergen-Specific IgE Testing","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"sample_size","value":"n=75","value_numeric":75},{"paper_doi":"10.1111/cea.70429","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"study_design","value":"Case-Control Study","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously: results are promising but based on a small single-country cohort requiring external validation before routine clinical adoption.","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"warning","value":"Total sample size tagged as n=75 (54 cases + 21 controls); the paper does not report an overall combined N explicitly.","value_numeric":null},{"paper_doi":"10.1111/cea.70429","tag_type":"warning","value":"WALDA encompasses wheat allergy triggered with augmentation factors (e.g., exercise, NSAIDs); it overlaps with wheat-dependent exercise-induced anaphylaxis (WDEIA) but is not identical — the paper does not specify the proportion with each trigger.","value_numeric":null}],"summaries":{"what_studied":"Serum IgE (sIgE) reactivity to 19 recombinant wheat proteins and the cross-reactive carbohydrate determinant (CCD) MUXF3 was assessed in 54 adults with challenge-confirmed wheat allergy dependent on augmentation factors (WALDA) versus 21 tolerant controls from two German centres.","key_result":"sIgE to α-/β-gliadin (Tri a 21.0101) was present in 53.7% of WALDA patients (29/54) and absent in all controls (100% specificity; AUC = 0.85; optimal cut-off 0.22 kU/l). Non-gluten protein reactivity was limited and largely driven by CCD cross-reactivity and grass pollen sensitization rather than true wheat allergy.","limitations":"- Small sample size (n=54 cases, n=21 controls) limits generalizability.\n- Controls included only 5 with positive sIgE to ω5-gliadin, making comparisons within that subgroup underpowered.\n- Single-country (German) cohort may not reflect wheat allergy phenotypes in other populations.","practice_takeaway":"Testing for sIgE to α-/β-gliadin (Tri a 21.0101) at a cut-off of 0.22 kU/l offers 100% specificity for WALDA and may be a more reliable diagnostic marker than ω5-gliadin alone. Clinicians should interpret non-gluten wheat protein sIgE results cautiously, as they often reflect CCD or grass pollen cross-reactivity rather than true wheat sensitization."}},{"doi":"10.1016/j.jaip.2026.04.009","pmid":"42019722","title":"Prevalence and clinical picture of wheat allergy in children: two observational studies in Germany","journal_title":"The Journal of Allergy and Clinical Immunology: In Practice","journal_issn":"2213-2198","published_at":"2026-04-20T00:00:00.000Z","url":"https://doi.org/10.1016/j.jaip.2026.04.009","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:49:56.913Z","updated_at":"2026-05-07T22:49:56.913Z","tags":[{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"age_group","value":"child","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"age_group","value":"infant","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"condition","value":"Food Allergy","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"condition","value":"Wheat Allergy","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"modality","value":"Allergen-Specific IgE Testing","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"modality","value":"Oral Food Challenge","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"sample_size","value":"n=1,381 (cohort); n=334 (cross-sectional)","value_numeric":1381},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"study_design","value":"Observational Study (Birth Cohort + Cross-Sectional)","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"warning","value":"The cross-sectional OFC cohort was recruited from specialist hospital centers, which may not reflect the general population — prevalence and severity data from this arm should not be generalized broadly.","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"warning","value":"The 'impact_flag' of practice_changing is applied cautiously: the finding that wheat-specific IgE is not diagnostically useful is a clinically meaningful message, but the study is observational and limited in sample size for the cohort arm.","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.04.009","tag_type":"warning","value":"The study design is labeled as two separate observational studies with different populations; the combined sample size tag reflects the larger birth cohort (n=1,381), but the OFC cross-sectional arm had n=334. Clinicians should interpret each result in its respective study context.","value_numeric":null}],"summaries":{"what_studied":"Two observational studies examined pediatric wheat allergy in Germany: (1) a population-based birth cohort (EuroPrevall, Berlin, n=1,381) tracking prevalence to age 2 years, and (2) a cross-sectional study across 5 German hospitals (n=334, median age 15 months) characterizing allergic reactions via oral food challenges (OFCs) and monitoring tolerance development in 50 rechallenged children.","key_result":"Wheat allergy prevalence was low at 0.2% (3/1,381) in the birth cohort. In the OFC study, 41% (137/334) reacted, with no child reacting to less than 32 mg of wheat protein. Wheat-specific IgE did not predict reactivity, severity, or threshold. Among 50 followed children, 46% (23/50) developed tolerance by a median age of 37 months.","limitations":"Birth cohort prevalence is based on a small number of confirmed cases (n=3), limiting precision. The cross-sectional OFC study was conducted at specialist centers, which may overrepresent sensitized or high-risk children. Follow-up data are available for only 50 of the 137 children who reacted.","practice_takeaway":"Wheat-specific IgE should not be used alone to confirm wheat allergy or predict reaction severity in children — OFC remains the diagnostic standard. Clinicians can counsel families that nearly half of wheat-allergic infants may outgrow their allergy by around 3 years of age."}},{"doi":"10.1111/pai.70274","pmid":"41482726","title":"Factors associated with false negative exercise provocation tests following exercise‐induced allergic reactions in children desensitized to wheat","journal_title":"Pediatric Allergy and Immunology","journal_issn":"0905-6157","published_at":"2026-01-03T00:00:00.000Z","url":"https://doi.org/10.1111/pai.70274","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-01-08","doi":"10.1111/pai.70274","days":"7","issn":"0905-6157","rank":"8","field":"Clinical Medicine","score":"1","category":"Allergy","categories":["Allergy"],"_categories":["Allergy"]},"pubmed":{"doi":"10.1111/pai.70274","title":"Factors associated with false negative exercise provocation tests following exercise-induced allergic reactions in children desensitized to wheat.","journal":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","methods":"","results":"Among 53 patients with negative/indeterminate EPT results, 14 (26.4%) experienced allergic symptoms during follow-up (Event+ group). Higher ω5-gliadin-specific IgE levels at the time of EPT were significantly associated with Event+. No other factors (i.e., age, sex, allergy severity, or exercise intensity) showed any association. All Event+ cases occurred outdoors, suggesting a possible influence of environmental factors.","abstract":"$30","keywords":["exercise provocation test","exercise‐induced allergic reactions on desensitization","oral immunotherapy","wheat allergy","ω5‐gliadin‐specific IgE"],"pubmed_id":"41482726","conclusions":"False negatives occurred in 26.4% of pediatric wheat-desensitized patients with EPTs. Our findings highlight the need to periodically monitor EIARD after negative EPT results. Future studies should explore methods to improve the accuracy of EPTs and identify predictive markers of EIARD risk.","publication_date":"2026-01-03T00:00:00"},"crossref":{"DOI":"10.1111/pai.70274","URL":"https://doi.org/10.1111/pai.70274","ISSN":["0905-6157","1399-3038"],"link":[{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/pai.70274","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":"1","score":1,"title":["Factors associated with false negative exercise provocation tests following exercise‐induced allergic reactions in children desensitized to wheat"],"author":[{"given":"Motohiro","family":"Mukai","sequence":"first","affiliation":[{"name":"Department of Allergy, Allergy and Immunology Center Aichi Children's Health and Medical Center Obu Japan"}]},{"given":"Teruaki","family":"Matsui","sequence":"additional","affiliation":[{"name":"Department of Allergy, Allergy and Immunology Center Aichi Children's Health and Medical Center Obu Japan"}]},{"given":"Katsumasa","family":"Kitamura","sequence":"additional","affiliation":[{"name":"Department of Allergy, Allergy and Immunology Center Aichi Children's Health and Medical Center Obu Japan"}]},{"given":"Yoshihiro","family":"Takasato","sequence":"additional","affiliation":[{"name":"Department of Allergy, Allergy and Immunology Center Aichi Children's Health and Medical Center Obu Japan"}]},{"given":"Shiro","family":"Sugiura","sequence":"additional","affiliation":[{"name":"Department of Allergy, Allergy and Immunology Center Aichi Children's Health and Medical Center Obu Japan"}]},{"given":"Komei","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Allergy, Allergy and Immunology Center Aichi Children's Health and Medical Center Obu Japan"},{"name":"Comprehensive Pediatric Medicine Nagoya University Graduate School of Medicine Nagoya Japan"}]}],"issued":{"date-parts":[[2026,1]]},"member":"311","prefix":"10.1111","source":"Crossref","volume":"37","archive":["Portico"],"created":{"date-time":"2026-01-03T06:33:53Z","timestamp":1767422033000,"date-parts":[[2026,1,3]]},"indexed":{"date-time":"2026-01-03T06:38:08Z","timestamp":1767422288080,"date-parts":[[2026,1,3]]},"license":[{"URL":"http://onlinelibrary.wiley.com/termsAndConditions#vor","start":{"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000,"date-parts":[[2026,1,2]]},"delay-in-days":1,"content-version":"vor"}],"subject":[],"abstract":"$31","language":"en","relation":{},"resource":{"primary":{"URL":"https://onlinelibrary.wiley.com/doi/10.1111/pai.70274"}},"subtitle":[],"assertion":[{"name":"received","group":{"name":"publication_history","label":"Publication History"},"label":"Received","order":0,"value":"2025-07-11"},{"name":"accepted","group":{"name":"publication_history","label":"Publication History"},"label":"Accepted","order":2,"value":"2025-12-18"},{"name":"published","group":{"name":"publication_history","label":"Publication History"},"label":"Published","order":3,"value":"2026-01-02"}],"deposited":{"date-time":"2026-01-03T06:33:57Z","timestamp":1767422037000,"date-parts":[[2026,1,3]]},"issn-type":[{"type":"print","value":"0905-6157"},{"type":"electronic","value":"1399-3038"}],"published":{"date-parts":[[2026,1]]},"publisher":"Wiley","reference":[{"DOI":null,"key":"e_1_2_10_2_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Consumer Affairs Agency Government of Japan.Fiscal Year Survey and Research Project on Food Labeling Related to Food Allergies Report.2024https://www.caa.go.jp/policies/policy/food_labeling/food_sanitation/allergy/assets/food_labeling_cms204_241031_1.pdf. 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allergic reactions in children desensitized to wheat","updated":"2026-01-04T00:51:16+00:00","published_date":"2026-01-01","best_oa_location":null}},"created_at":"2026-01-11T11:19:33.869Z","updated_at":"2026-01-15T20:51:27.064Z","tags":[{"paper_doi":"10.1111/pai.70274","tag_type":"age_group","value":"adolescent","value_numeric":null},{"paper_doi":"10.1111/pai.70274","tag_type":"age_group","value":"child","value_numeric":null},{"paper_doi":"10.1111/pai.70274","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.1111/pai.70274","tag_type":"condition","value":"Exercise-Induced Allergic Reactions","value_numeric":null},{"paper_doi":"10.1111/pai.70274","tag_type":"condition","value":"Wheat Allergy","value_numeric":null},{"paper_doi":"10.1111/pai.70274","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1111/pai.70274","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/pai.70274","tag_type":"modality","value":"Oral Immunotherapy","value_numeric":null},{"paper_doi":"10.1111/pai.70274","tag_type":"sample_size","value":"n=53","value_numeric":53},{"paper_doi":"10.1111/pai.70274","tag_type":"study_design","value":"Retrospective Cohort","value_numeric":null},{"paper_doi":"10.1111/pai.70274","tag_type":"warning","value":"All events occurred outdoors, but environmental contributors were not measured; interpret cautiously.","value_numeric":null},{"paper_doi":"10.1111/pai.70274","tag_type":"warning","value":"EPT was universal after rush OIT but only for high‑risk slow OIT, which may introduce selection differences.","value_numeric":null},{"paper_doi":"10.1111/pai.70274","tag_type":"warning","value":"False‑negative rate and associations derive from the negative/indeterminate EPT subset (n=53), not the entire cohort (n=109).","value_numeric":null},{"paper_doi":"10.1111/pai.70274","tag_type":"warning","value":"Severity of allergic events and specific ω5‑gliadin IgE cutoffs were not provided.","value_numeric":null}],"summaries":{"what_studied":"Retrospective cohort of 109 children (5–18 years) undergoing exercise provocation testing (EPT) after wheat oral immunotherapy from 2012–2023; those with negative/indeterminate EPT (n=53) were followed for 1 year to detect exercise‑induced allergic reactions after wheat ingestion.","key_result":"Among 53 with negative/indeterminate EPT, 14 developed allergic symptoms during follow‑up (26.4% false‑negative rate). Higher ω5‑gliadin‑specific IgE at the time of EPT was associated with events; age, sex, allergy severity, and exercise intensity were not; all events occurred outdoors.","limitations":"Outcomes and false‑negative rate were based only on the 53 with negative/indeterminate EPT, not the full 109. The retrospective design limits control of confounders, and event severity and ω5‑gliadin IgE thresholds were not reported.","practice_takeaway":"A negative EPT after wheat OIT does not rule out exercise‑induced reactions; about 1 in 4 reacted within 1 year. Continue periodic monitoring and consider ω5‑gliadin‑specific IgE as a risk marker when counseling families, especially for outdoor exercise settings."}}],"initialOffset":3,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Wheat Allergy"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Wheat Allergy"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Wheat Allergy"}}}]]

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