A rare case of wheat-dependentexercise-induced anaphylaxis induced by exercise 5 hours after wheat ingestion.Tomoki Yaguchi1, Katsutoshi Nakano1, Tadayuki Kumagai1Department of Pediatrics, Yaizu City Hospital, Shizuoka, JapanCorresponding authorTomoki Yaguchi, 1000, Dobara, Yaizu-shi, Shizuoka 425-0055, Japan. Phone: +81-54-623-3111, Fax: +81-54-624-9103, E-mail: ravvvvish@gmai.l.comWord Count for Main Text; 916The number of Table; 1, Figure; 0Keywords：wheat-dependent exercise-induced anaphylaxis, food allergy, aspirin, sensitization, anaphylaxis

To elucidate the genetic mechanisms of recurrence and metastasis in clear cell sarcoma of the kidney (CCSK), a dismal pediatric renal cancer, we performed targeted-capture sequencing by pediatric solid tumors panel (381 genes) for multi-sampled tumors including autopsy samples of metastasis extracted from a single case that underwent four relapses. Internal tandem duplication of BCOR (BCOR-ITD) was the only truncal mutation, indicating a strong association with tumorigenesis. Acquisition of additional mutations along tumor relapses and detection of metastasis-specific mutations were reminiscent of the tumor progression and therapeutic resistance of this case, leading to clonal selection and a dismal fate.