Omega-5-Gliadin Allergy and Cofactors Leading to Anaphylaxis: A Case Report.

Anaphylaxis, a potentially life-threatening systemic reaction, is an increasingly common reason for emergency department (ED) admissions, which often poses diagnostic challenges. We present a case of a 62-year-old man who had recurrent anaphylaxis, initially suspected to be triggered by non-steroidal anti-inflammatory drugs (NSAIDs). By conducting thorough history-taking and comprehensive allergy testing, we identified allergic sensitization to the omega-5-gliadin (O5G) component of gluten, which manifested only when wheat consumption was accompanied by specific factors, notably exercise or NSAID use. He was diagnosed eight years after the first anaphylactic episode with wheat-dependent exercise-induced anaphylaxis (WDEIA). Adherence to a gluten-free diet effectively prevented further episodes. This case underscores the importance of emergency physicians not only in treating anaphylaxis but also in recognizing rare diagnoses, such as cofactor-enhanced food-induced allergic reactions, and understanding their management. This awareness is critical not only for conducting comprehensive assessments in collaboration with allergy specialists but also for facilitating earlier diagnosis, educating patients about the use of epinephrine auto-injectors, and emphasizing essential avoidance measures to prevent the recurrence of anaphylaxis.