Wheat-Based Glues in Conservation and Cultural Heritage: (Dis)solving the Proteome of Flour and Starch Pastes and Their Adhering Properties.

Plant-based adhesives, such as those made from wheat, have been prominently used for books and paper-based objects and are also used as conservation adhesives. Starch paste originates from starch granules, whereas flour paste encompasses the entire wheat endosperm proteome, offering strong adhesive properties due to gluten proteins. From a conservation perspective, understanding the precise nature of the adhesive is vital as the longevity, resilience, and reaction to environmental changes can differ substantially between starch- and flour-based pastes. We devised a proteomics method to discern the protein content of these pastes. Protocols involved extracting soluble proteins using 0.5 M NaCl and 30 mM Tris-HCl solutions and then targeting insoluble proteins, such as gliadins and glutenins, with a buffer containing 7 M urea, 2 M thiourea, 4% CHAPS, 40 mM Tris, and 75 mM DTT. Flour paste's proteome is diverse (1942 proteins across 759 groups), contrasting with starch paste's predominant starch-associated protein makeup (218 proteins in 58 groups). Transformation into pastes reduces proteomes' complexity. Testing on historical bookbindings confirmed the use of flour-based glue, which is rich in gluten and serpins. High levels of deamidation were detected, particularly for glutamine residues, which can impact the solubility and stability of the glue over time. The mass spectrometry proteomics data have been deposited to the ProteomeXchange, Consortium (http://proteomecentral.proteomexchange.org) via the MassIVE partner repository with the data set identifier MSV000093372 (ftp://MSV000093372@massive.ucsd.edu).

Consumer-Led Investigation into Potential Issues That Arise When Testing Dairy Matrixes for Gluten With the NIMA Sensor.

BACKGROUND: Some consumers with celiac disease use personal, point-of-use gluten detection devices to test food. False-positive results may occur due to sampling, matrix effects, and sensor issues. OBJECTIVE: The purpose of the present study was to determine if the positive gluten results some users were obtaining when testing cream cheese and materials of similar consistency were false positives and, if so, what might be causing them to occur. METHODS: Cream cheese, soft cheese, and yogurt were tested for gluten using the Ridascreen Gliadin R7001 sandwich R5 ELISA and the Ridascreen Gliadin R7021 competitive R5 ELISA. Two test portions were taken, extracted, and tested from each homogenized material. Materials were also analyzed for gluten using a NIMA sensor, a personal, point-of-use gluten detection device. Multiple test portion weights were tested beginning at 0.13 to 0.17 g (the ideal weight of the test portion according to the NIMA sensor development team). RESULTS: Using the sandwich R5 ELISA and the competitive R5 ELISA, all materials tested below the lower LOD for gluten. Using a NIMA sensor, as the weight of the test portion tested increased, sensor results went from no gluten found, to gluten found, to no test result. CONCLUSION: The gluten found results using the NIMA sensor are likely false positives that appear to correspond with the weight and volume of the material tested, as well as the viscosity. There is also an apparent disconnect between the gluten found result reported by the sensor and an interpretation of the lateral flow device (LFD) strip result when assessed by eye which should also be taken into account. Ideally, NIMA sensor users should be advised on the weight amount of material to analyze and test portions should be weighed before being used with the NIMA sensor. However, this is not a practical solution when testing in many environments, including restaurants. HIGHLIGHTS: Slight variations in weight and volume of test materials can result in false positive results when testing dairy matrixes for gluten using the Nima sensor.

Does Nitrogen Fertilization Affect the Secondary Structures of Gliadin Proteins in Hypoallergenic Wheat?

One of the macronutrients indispensable for plant growth and development is nitrogen (N). It is responsible for starch and storage protein (gliadins and glutenins) biosynthesis and, in consequence, influences kernels' quality and yields. However, applying N-fertilizers increases gluten content in wheat, and it may intensify the risk of developing allergy symptoms in gluten-sensitive individuals. The purpose of our research was to analyse whether and how the elimination of N-fertilizers during the cultivation of wasko.gl- wheat (modified genotype lacking ω-gliadins) changes the secondary structures of gliadin proteins. To this aim, using the FT-Raman technique, we examined flour and gliadin protein extracts obtained from kernels of two winter wheat lines: wasko.gl+ (with a full set of gliadin proteins) and wasko.gl- (without ω-gliadin fraction) cultivated on two different N-fertilization levels-0 and 120 kg N·ha-1. On the basis of the obtained results, we proved that nitrogen fertilization does not have a major impact on the stability of the secondary structures of gliadin proteins for wasko.gl- wheat line with reduced allergenic properties. Furthermore, the results presented herein suggest the possibility of increasing the stability of glutenin structures as a result of the N-fertilization of wasko.gl- wheat line, which gives hope for its use in the production of wheat articles devoted to people suffering from diseases related to gluten sensitivity.

Determination of Gliadin as a Measure of Gluten in Food by R5 Sandwich ELISA RIDASCREEN® Gliadin Matrix Extension: Collaborative Study 2012.01.

BACKGROUND: According to Codex Alimentarius, food products containing less than 20 mg/kg gluten can be labeled as "gluten-free." Since 2002, the R5 antibody method allowed determination of gluten levels and led to a huge improvement of products available to celiac disease (CD) patients. METHOD: The R5-containing test kit RIDASCREEN® Gliadin in combination with the cocktail solution was endorsed as Codex Type 1 Method in 2006 based on a collaborative study with corn-based bread, rice-based dough, wheat starches, rice, and corn flour. In 2012, the method was approved as First Action Official MethodSM2012.01 with an "in foods" claim. For Final Action in 2016, the matrix claim was reduced to rice- and corn-based matrixes. OBJECTIVE: Therefore, R-Biopharm decided to start a collaborative study to demonstrate the wide applicability of Official Method 2012.01 for the quantitative analysis of gliadin in soy, starches, pseudo cereals, legumes, spices, juice, nut nougat crème, cream cheese, pesto, meat, vegetarian meat alternative, cookies, dessert, cake, fish, bread, candies, and potatoes. Materials for incurring were the MoniQA wheat flour and the PWG gliadin preparation. RESULTS: Gliadin levels ranged from 3.4 up to 27.4 mg gliadin per kg. The results of the collaborative study with 14 participating laboratories showed recoveries ranging from 80 to 130%. Relative reproducibility standard deviations for contaminated samples were between 9.8 and 27.7%. CONCLUSIONS: The collaborative study results confirmed that the method is accurate and suitable to measure gliadin in important gluten-free food matrixes. HIGHLIGHTS: The title and applicability statement of Official Method 2012.01 were changed as proposed.

Characterization of gliadin, secalin and hordein fractions using analytical techniques.

Prolamins, alcohol soluble storage proteins of the Triticeae tribe of Gramineae family, are known as gliadin, secalin and hordein in wheat, rye and barley respectively. Prolamins were extracted from fifteen cultivars using DuPont protocol to study their physiochemical, morphological and structural characteristics. SDS-PAGE of prolamins showed well resolved low molecular weight proteins with significant amount of albumin and globulin as cross-contaminant. The ß-sheet (32.72-37.41%) and ß-turn (30.36-37.91%) were found higher in gliadins, while α-helix (20.32-28.95%) and random coil (9.05-10.28%) in hordeins. The high colloidal stability as depicted by zeta-potential was observed in gliadins (23.5-27.0 mV) followed secalins (11.2-16.6 mV) and hordeins (4.1-7.8 mV). Surface morphology by SEM illustrated the globular particle arrangement in gliadins, sheet like arrangement in secalins and stacked flaky particle arrangement in hordeins fraction. TEM studies showed that secalin and hordein fractions were globular in shape while gliadins in addition to globular structure also possessed rod-shaped particle arrangement. XRD pattern of prolamin fractions showed the ordered crystalline domain at 2θ values of 44.1°, 37.8° and 10.4°. The extracted prolamins fractions showed amorphous as well as crystalline structures as revealed by XRD and TEM analysis. Space saving hexagonal molecular symmetry was also observed in TEM molecular arrangement of prolamins which has profound application in development of plant-based polymers and fibres.

A biomimetic "intestinal microvillus" cell sensor based on 3D bioprinting for the detection of wheat allergen gliadin.

A biomimetic "intestinal microvillus" electrochemical cell sensor based on three-dimensional (3D) bioprinting was developed, which can specifically and accurately detect wheat gliadin. Self-assembled flower-like copper oxide nanoparticles (FCONp) and hydrazide-functionalized multiwalled carbon nanotubes (MWCNT-CDH) were innovatively synthesized to improve the sensor performance. A conductive biocomposite hydrogel (bioink) was prepared by mixing FCONp and MWCNT-CDH based on GelMA gel. The cluster-shaped microvillus structure of small intestine was accurately printed on the screen printing electrode with the prepared bioink using stereolithography 3D-bioprinting technology, and then the Rat Basophilic Leukemia cells were immobilized on the gel skeleton. Next, the developed cell sensor was used to effectively detect wheat allergen gliadin. The experimental results show that the bioprinted cell sensor sensitively detects wheat gliadin when the optimized cell numbers and immobilized time are 1 × 106 cells/mL and 10 min, respectively. The linear detection range is 0.1-0.8 ng/mL, and the detection limit is 0.036 ng/mL. The electrochemical cell sensor based on 3D printing technology has excellent stability and reproducibility. Thus, a simple and novel electrochemical detection approach for food allergens was established in this study with potential application in food safety detection and evaluation.

Gluten Degradation, Pharmacokinetics, Safety, and Tolerability of TAK-062, an Engineered Enzyme to Treat Celiac Disease.

BACKGROUND AND AIMS: Celiac disease (CeD) is an immune-mediated disorder triggered by the ingestion of gluten. Despite adhering to a gluten-free diet (the only management option available to patients with CeD), many patients continue to experience symptoms and intestinal injury. Degradation of immunogenic fractions of gluten peptides in the stomach has been proposed as an approach to reduce toxicity of ingested gluten; however, no enzymes evaluated to date have demonstrated sufficient gluten degradation in complex meals. TAK-062 is a novel, computationally designed endopeptidase under development for the treatment of patients with CeD. METHODS: Pharmacokinetics, safety, and tolerability of TAK-062 100-900 mg were evaluated in a phase I dose escalation study in healthy participants and patients with CeD. Gluten degradation by TAK-062 was evaluated under simulated gastric conditions in vitro and in healthy participants in the phase I study, with and without pretreatment with a proton pump inhibitor. Residual gluten (collected through gastric aspiration in the phase I study) was quantified using R5 and G12 monoclonal antibody enzyme-linked immunosorbent assays. RESULTS: In vitro, TAK-062 degraded more than 99% of gluten (3 g and 9 g) within 10 minutes. In the phase I study, administration of TAK-062 was well tolerated and resulted in a median gluten degradation ranging from 97% to more than 99% in complex meals containing 1-6 g gluten at 20-65 minutes postdose. CONCLUSIONS: TAK-062 is well tolerated and rapidly and effectively degrades large amounts of gluten, supporting the development of this novel enzyme as an oral therapeutic for patients with CeD. (ClinicalTrials.gov: NCT03701555, https://clinicaltrials.gov/ct2/show/NCT03701555.).

An electrochemical microfluidic biochip for the detection of gliadin using MoS2/graphene/gold nanocomposite.

Testing gluten content in food, before it reaches the consumer, becomes a major challenge where cross-contamination during processing and transportation is a very common occurrence. In this study, a microfluidic electrochemical aptasensing system for the detection of gliadin has been proposed. The fabrication of the sensor involves its modification by using a combination of 2D nanomaterial molybdenum disulfide (MoS2)/graphene with the addition of gold (Au) nanoparticles. Aptamers, a short string of nucleotide bases that are very specific to gliadin, were used in this sensor as the biomarker. The electrochemical standard reduction potential of the ferro-ferricyanide indicator was found to be ~ 530 mV. This setup was integrated with a unique polydimethylsiloxane (PDMS)-based flexible microfluidic device for sample enrichment and portability. The results of this sensor show that the limit of detection was 7 pM. The total sample assay time was 20 min and a good linear range was observed from 4 to 250 nM with an R2 value of 0.982. Different flour samples sourced from the local market were tested and interfering molecules were added to ensure selectivity. The study shows promise in its applicability in real-time gliadin detection.Graphical abstract.

X6: A Novel Antibody for Potential Use in Gluten Quantification.

Gliadin is a fraction of gluten, known to trigger celiac disease in susceptible people. To date, the life-long gluten-free diet is used for the prevention of this disease. Hence, methods for gluten control in foods are of significant importance. Being one of the most-used methods used for this purpose, ELISA should use high-affinity antibodies to gliadin peptides involved into celiac process. This study investigates the characteristics of a novel anti-gliadin antibody X6. We found the QXQPFPXP site to be a recognized epitope that provides specific binding of the antibody to cereal prolamins involved in celiac disease manifestation. A specificity study using immunoblotting shows the recognition of wheat, barley and rye proteins-as well as α-gliadin homologs from non-edible cereals (Dasypyrum villosum). Reactivity to avenin was less pronounced, as this protein does not contain the PFP motif most critical for antibody recognition. The proteins of Zea mays and Setaria italica were not recognized by X6. X6-based ELISA highly correlated with R5 and G12, which are Codex Alimentarius standards in the quantitative assessment of gluten content (Pearson's R = 0.86 and 0.87, respectively). Qualitative assessment revealed no significant differences between R5 and G12 and X6.

Wheat (Triticum aestivum L.) Breeding from 1891 to 2010 Contributed to Increasing Yield and Glutenin Contents but Decreasing Protein and Gliadin Contents.

Epidemiologic studies suggest an increasing prevalence of celiac disease and non-celiac gluten/wheat sensitivity. With wheat proteins being the main triggers, changes in wheat protein composition are discussed as a potential cause. The goals of breeding toward increased yield and resistance might have inadvertently contributed to a higher immunostimulatory potential of modern wheat cultivars compared to old wheat cultivars. Therefore, agronomic characteristics, protein content, and gluten composition of 60 German winter wheat cultivars first registered between 1891 and 2010 grown in 3 years were analyzed. While plant height and spike density decreased over time, yield and harvest index increased. The protein and gliadin contents showed a decreasing trend, whereas glutenin contents increased, but there were no changes in albumin/globulin and gluten contents. Overall, the harvest year had a more significant effect on protein composition than the cultivar. At the protein level, we found no evidence to support an increased immunostimulatory potential of modern winter wheat.

Development of a nano biosensor for anti-gliadin detection for Celiac disease based on suspension microarrays.

Celiac disease is an autoimmune disorder represented by the ingestion of the gluten protein usually found in wheat, barley and rye. To date, ELISA has been the most accurate method for determining the presence of anti-gliadin, which is cumbersome, expensive (compared to a suspension microarray technique), and requires extensive sample preparation. In this study, in order to establish a more accurate assay to identify gliadin at lower concentrations, optical nano biosensors using an indirect immunoassay method for gliadin detection was designed and fabricated. For this, polycaprolactone (PCL) nano- to micro-beads were fabricated as a platform for the gliadin antigen which were optimized and nano functionalized with amine groups for such purposes. The gliadin antibody, which is selective to gliadin, was then added to the beads. Static light scattering tests were conducted to determine PCL particle size distribution and sizes were found from 0.1 to 30 µm, which is suitable for flowcytometry detection devices. Anti-gliadin detection was performed using an anti IgG mouse antibody conjugated with FITC in a flow cytometry device to detect the smallest particle. Fluorescence intensity was investigated at different concentrations of anti-gliadin and a standard curve used to determine gluten concentration based on fluorescence intensity. Results showed that the fluorescence intensity increased with greater concentrations of anti-gliadin providing a very effective method of detection due to selectivity at a 5 ppm detection limit. This represents a new highly sensitive and fast method for anti-gliadin detection. Further, the disuse of a cross linker and the use of a dedicated antibody at a very low level (1 µl) made this new method very economical to identify anti-gliadin concentrations at the nano level. In summary, this study provides a new, more accurate and sensitive, as well as less expensive system to detect anti-gliadin for the improved diagnosis of celiac disease.

Exploiting the reference genome sequence of hexaploid wheat: a proteomic study of flour proteins from the cultivar Chinese Spring.

Although the economic value of wheat flour is determined by the complement of gluten proteins, these proteins have been challenging to study because of the complexity of the major protein groups and the tremendous sequence diversity among wheat cultivars. The completion of a high-quality wheat genome sequence from the reference wheat Chinese Spring recently facilitated the assembly and annotation of a complete set of gluten protein genes from a single cultivar, making it possible to link individual proteins in the flour to specific gene sequences. In a proteomic analysis of total wheat flour protein from Chinese Spring using quantitative two-dimensional gel electrophoresis combined with tandem mass spectrometry, gliadins or low-molecular-weight glutenin subunits were identified as the predominant proteins in 72 protein spots. Individual spots were associated with 40 of 56 Chinese Spring gene sequences, including 16 of 26 alpha gliadins, 10 of 11 gamma gliadins, six of seven omega gliadins, one of two delta gliadins, and nine of ten LMW-GS. Most genes that were not associated with protein spots were either expressed at low levels in endosperm or encoded proteins with high similarity to other proteins. A wide range of protein accumulation levels were observed and discrepancies between transcript levels and protein levels were noted. This work together with similar studies using other commercial cultivars should provide new insight into the molecular basis of wheat flour quality and allergenic potential.

In vitro selection of anti-gliadin single-domain antibodies from a naïve library for cDNA-display mediated immuno-PCR.

Gluten intolerance, or adverse intestinal reactions to gluten, is a fairly common problem among certain groups of people. Celiac disease is the most severe form of gluten intolerance, which can lead to permanent damage in the digestive system. Since lifelong avoidance of gluten is the only available treatment, development of reliable techniques to identify gluten contamination in food is important. Gliadin, a component of gluten, is known to play a major role in gluten toxicity. In this study, cDNA display method was used to select specific single-domain antibodies against toxic gliadin from an alpaca-derived naïve VHH library. The cDNA display method is a promising in vitro display technique, which uniquely converts an unstable mRNA-protein fusion molecule to a stable mRNA/cDNA-protein fusion molecule using a well-designed puromycin linker. Three candidate VHHs were selected and the affinities of the VHHs were observed by pulldown assay and indirect ELISA method. In addition, a novel cDNA display mediated immuno-PCR method (cD-IPCR) was successfully applied to detect gliadin in food. We believe this work demonstrates the potential application of the cDNA display method in selecting binders against toxic and heterogeneous targets such as gliadin with an immunization-free preparation manner.

Effects of water deficit and different nitrogen fertilizer treatments on the quality of wheat for Chinese fresh white noodles and steamed bread and the composition of storage proteins.

BACKGROUND: Noodles and steamed bread are popular wheat products consumed worldwide, particularly in China and other Asian countries. We performed the first comprehensive study of the influence of water deficits and different nitrogen fertilizer applications on two elite Chinese bread wheat cultivars, Zhongmai 175 and Jimai 22, which are distinct in gluten strength. These wheat cultivars were tested to determine the qualities that are optimal for the production of Chinese fresh white noodles (CFWN) and northern-style Chinese steamed bread (NCSB), and storage protein composition. RESULTS: Water deficit and high nitrogen (N) fertilizer application promoted total grain protein content and the accumulation of gliadins and glutenins, while low N resulted in the opposite results. Water deficit and high N fertilizer in Jimai 22, with medium-to-strong gluten strength significantly improved NCSB and CFWN qualities. The quality of CFWN under low N, and that of NCSB under both high and low N conditions, was significantly reduced. However, NCSB and CFWN quality in Zhongmai 175 with weak-to-medium gluten strength was not significantly affected by water deficit and different N fertilizer applications. Grain subproteome analysis revealed that considerable cultivar-specific gliadins and glutenins showed significant accumulation changes in response to water deficit and high / low N fertilizer treatment, which could be responsible for NCSB and CFWN quality changes under different treatments. CONCLUSION: Water deficit and high / low N fertilizer treatments caused changes in cultivar-specific storage protein composition, resulting in differences in the accumulation of gliadins, glutenins, and the quality of NCSB and CFWN. © 2019 Society of Chemical Industry.

Simultaneous immunofluorescent imaging of gliadins, low molecular weight glutenins, and high molecular weight glutenins in wheat flour dough with antibody-quantum dot complexes.

Gluten proteins and their impact in the quality of wheat based food products is well known. In order visualize the 'in situ' distribution of low molecular weight glutenins, high molecular weight glutenins, and gliadins simultaneously in wheat doughs we needed to overcome and eliminate dough auto-fluorescence, and to develop a reliable immunostaining procedure for their simultaneous detection in wheat doughs. We are studying different auto-fluorescence quenchers used in biological fluorescent imaging and their effect on dough auto-fluorescence removal, and the effect of different fixative mediums on the adhesion of wheat flours doughs onto microscope slides. We found that the best method to remove dough auto-fluorescence is removing it as background in the microscope detection system. We also found methanol to be the best fixative medium for dough samples. In this research, we are showing the first 'in situ' localization of these gluten subunits simultaneously in wheat flour dough.

Independent and combined effects of elevated CO2 and post-anthesis heat stress on protein quantity and quality in spring wheat grains.

Spring wheat plants were grown under two CO2 concentrations (380 and 550 µmol mol-1) and two temperature treatments (ambient and post-anthesis heat stress) to investigate the effects of elevated CO2 and heat stress on grain protein quality. Contents of protein components, glutenin macropolymers (GMP) and amino acids in grains decreased due to elevated CO2, while increased by high temperature. The combination of elevated CO2 and heat stress increased the contents of total protein and albumin, but decreased the contents of gliadin and glutenin, while the content and particle size distribution of GMP as well as the contents of amino acids were not significantly affected. Furthermore, we found that the content and particle size distribution of GMP were not only determined by the contents of proteins and high-molecular-weight glutenin subunits, but also related to the contents of amino acids containing disulfide bonds, which favor the formation of large insoluble polymers.

Influence of infant feeding on the excretion of gluten immunopeptides in feces.

INTRODUCTION: the secretion of antigens from the diet into breast milk has been extensively documented. The transfer of gliadin could be critical for the development of an immune response. OBJECTIVES: to investigate the presence of immunogenic gluten peptides in the feces of infants fed with different diets. MATERIAL AND METHODS: a blind, prospective, controlled, collaborative study was performed in three hospitals, between September 2016 and January 2017. The study protocol was approved by the Ethics Committee of the hospitals in Seville prior to starting the study. RESULTS: the cohort was divided into three groups of 30 infants: an experimental group (average age 9.2 ± 2.8 weeks) with exclusive breastfeeding, a control group 1 (average age 10.3 ± 3.3 weeks) exclusively fed with onset formula and a control group 2 (average age 56 ± 3.7 weeks) with infants that consumed gluten on a regular basis. The peptide 33-mer of gliadin was negative in all feces samples from both the experimental and control group 1. With regard to control group 2, the peptide 33-mer of gliadin was negative in 23% of cases (seven children). There was no difference in the amount of gluten ingested by these children compared to those who excreted the 33-mer peptide. CONCLUSIONS: the failure to detect gluten in the feces of infants that were exclusively breastfed indicates that it is probably below the limits of detection. Healthy children who consume gluten may not excrete it in feces.

The Dietary Intervention of Transgenic Low-Gliadin Wheat Bread in Patients with Non-Celiac Gluten Sensitivity (NCGS) Showed No Differences with Gluten Free Diet (GFD) but Provides Better Gut Microbiota Profile.

The study evaluated the symptoms, acceptance, and digestibility of bread made from transgenic low-gliadin wheat, in comparison with gluten free bread, in Non-coeliac gluten sensitivity (NCGS) patients, considering clinical/sensory parameters and gut microbiota composition. This study was performed in two phases of seven days each, comprising a basal phase with gluten free bread and an E82 phase with low-gliadin bread. Gastrointestinal clinical symptoms were evaluated using the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire, and stool samples were collected for gluten immunogenic peptides (GIP) determination and the extraction of gut microbial DNA. For the basal and E82 phases, seven and five patients, respectively, showed undetectable GIPs content. The bacterial 16S rRNA gene V1-V2 hypervariable regions were sequenced using the Illumina MiSeq platform and downstream analysis was done using a Quantitative Insights into Microbial Ecology (QIIME) pipeline. No significant differences in the GSRS questionnaires were observed between the two phases. However, we observed a significantly lower abundance of some gut genera Oscillospira, Dorea, Blautia, Bacteroides, Coprococcus, and Collinsella, and a significantly higher abundance of Roseburia and Faecalibacterium genera during the E82 phase compared with the basal phase. The consumption of low-gliadin bread E82 by NCGS subjects induced potentially positive changes in the gut microbiota composition, increasing the butyrate-producing bacteria and favoring a microbial profile that is suggested to have a key role in the maintenance or improvement of gut permeability.

A New Diagnostic Criteria of Wheat-Dependent, Exercise-Induced Anaphylaxis in China.

BACKGROUND: Wheat-dependent, exercise-induced anaphylaxis (WDEIA) is an allergic reaction induced by intense exercise combined with wheat ingestion. The gold standard for diagnosis of WDEIA is a food exercise challenge; however, this test is unacceptable for Chinese WDEIA patients and unable to be approved by the Ethics Committee of Chinese hospitals due to substantial risk. There are no diagnostic criteria for Chinese WDEIA patients. The aim of present study was to propose new practical diagnosis criteria for Chinese WDEIA patients. METHODS: We prospectively included 283 clinically diagnosed WDEIA patients from January 1, 2010 to June 30, 2014, and in the meanwhile, three groups were enrolled which included 133 patients with the history of anaphylaxis induced by food other than wheat, 186 recurrent urticaria patients, and 94 healthy participants. Clinical comprehensive evaluation by allergists used as the reference gold standard, receiver operator characteristic (ROC) curves were plotted, areas under curve (AUC) for specific immunoglobin E (sIgE) were compared to evaluate the diagnostic value of IgE specific to wheat, gluten, and ω-5 gliadin. Patients were followed up by telephone questionnaire 1 year after diagnosis. RESULTS: We reviewed 567 anaphylactic reactions in 283 WDEIA patients. Of these anaphylactic reactions, 415 (73.3%) reactions were potentially life-threatening anaphylaxis. Among the 567 anaphylactic reactions, 75% (425/567) occurred during exercise. The highest AUC (0.910) was observed for sIgE for gluten, followed by omega-5 gliadin (AUC 0.879). Combined gluten- and ω-5 gliadin-specific IgE testing provided sensitivity and specificity of 73.1% and 99.0%, respectively. During the 1-year follow-up period, repeat anaphylaxis was rare when patients observed strict avoidance of wheat products combined with exercise or other triggering agents. CONCLUSIONS: In this study, we proposed diagnostic criteria and management of WDEIA patients in China. Our present study suggested that confirmed anaphylactic reactions triggered by wheat with positive sIgE to gluten and omega-5-gliadin may provide supportive evidence for clinicians to make WDEIA diagnosis without performing a food exercise challenge.