Wheat Allergy

What happens in a wheat allergy

The immune system mistakes a wheat protein for a threat and makes IgE antibodies against it. These antibodies sit on mast cells in the skin, gut and airways. The next time wheat is eaten or inhaled, the mast cells release histamine and other chemicals, causing symptoms within minutes to about 2 hours.

Wheat contains several types of protein that can trigger allergy, including albumins, globulins, gliadins and glutenins (the last two make up gluten). Allergy to omega-5 gliadin is linked to the more severe reactions and to exercise-induced anaphylaxis.

Types of wheat allergy

• Food allergy in children: the most common form. Often appears in infancy when wheat cereals are introduced, frequently alongside atopic dermatitis or other food allergies.
• Wheat-dependent exercise-induced anaphylaxis (WDEIA): reactions occur only when wheat is eaten and followed within a few hours by exercise. Alcohol, NSAIDs and fatigue can also act as cofactors. Mostly in teens and adults.
• Baker's asthma and rhinitis: an allergy to inhaled flour dust, a common occupational asthma in bakers, millers and pastry chefs.
• Contact urticaria: hives where the skin touches wheat, such as in some cosmetics.

Symptoms

• Hives, itching, redness or swelling of the skin, lips or face
• Itching or tingling in the mouth or throat
• Nausea, vomiting, belly cramps and diarrhea
• Sneezing, runny nose and itchy eyes
• Coughing, wheezing or shortness of breath
• Eczema flares in young children
• Anaphylaxis: a severe, whole-body reaction with breathing difficulty, throat swelling, low blood pressure, dizziness or collapse

Wheat allergy vs celiac disease vs gluten sensitivity

Some people can have more than one of these conditions.

Diagnosis

An allergist will take a detailed history of what was eaten, the symptoms and their timing, then may use:

• Skin prick testing: a small amount of wheat extract on the skin. A raised bump suggests sensitization.
• Specific IgE blood tests to wheat, and to components such as omega-5 gliadin.
• Oral food challenge: eating gradually increasing amounts of wheat under medical supervision. This is the most accurate test and is used to confirm the allergy or check whether it has been outgrown.

Positive skin or blood tests alone do not prove allergy, since many people with grass pollen allergy test positive to wheat without reacting to eating it. Testing should be guided by symptoms.

Living with wheat allergy

Reading labels

In the US, wheat is one of the major allergens that must be declared in plain language on packaged food labels. Check every label every time, as recipes change. Wheat can appear as:

• Flour of all kinds (white, whole wheat, enriched, graham, durum)
• Semolina, spelt, farro, einkorn, emmer, kamut, bulgur, couscous, seitan
• Breadcrumbs, crackers, cereal extract, wheat starch, hydrolyzed wheat protein, wheat germ

Common sources include bread, pasta, baked goods, cereals, batter-coated foods, soy sauce, gravies and sauces, beer, some sausages, and play dough.

"Gluten-free" products are usually wheat-free, but not always: some contain gluten-free wheat starch, which can still trigger wheat allergy. Look for the word "wheat" on the label.

Safe alternatives

Rice, corn, oats (labeled gluten-free to avoid wheat cross-contact), quinoa, buckwheat, millet, sorghum, potato, tapioca and amaranth. Most people with wheat allergy tolerate barley and rye, but some react, so ask your allergist before including them.

Emergency plan

• Carry two epinephrine auto-injectors if prescribed, and know how to use them.
• Have a written anaphylaxis action plan, and share it with schools, caregivers and coworkers.
• For WDEIA, avoid wheat for at least 4 to 6 hours before exercise.

Nutrition

Wheat is a major source of fiber, B vitamins and iron. A dietitian can help plan a balanced wheat-free diet, especially for children.

Outlook

Most children with wheat allergy outgrow it. Studies suggest around two-thirds do so by age 12, and many by school age. Allergists retest periodically and may offer a supervised food challenge. Adult-onset wheat allergy and WDEIA are more likely to persist. Oral immunotherapy for wheat is being studied in research settings.

Frequently asked questions

What are the symptoms of a wheat allergy?

Symptoms include hives, itching, swelling of the lips or face, nausea, vomiting, belly pain, diarrhea, sneezing, wheezing and, in severe cases, anaphylaxis. They usually start within minutes to 2 hours of eating or inhaling wheat.

Is wheat allergy the same as celiac disease?

No. Wheat allergy is an IgE allergic reaction that can cause anaphylaxis and is often outgrown. Celiac disease is a lifelong autoimmune condition triggered by gluten in wheat, barley and rye, which damages the small intestine. They are tested and managed differently.

Can adults develop a wheat allergy?

Yes. Although most wheat allergy starts in childhood, adults can develop it, including wheat-dependent exercise-induced anaphylaxis and baker's asthma from inhaled flour. Adult-onset wheat allergy is less likely to go away.

Can you eat gluten-free food with a wheat allergy?

Usually, but check the label. Most gluten-free foods are wheat-free, but some contain specially processed wheat starch that is low in gluten but still contains wheat proteins. Look for the word "wheat" in the ingredients and allergen statement.

Do children outgrow wheat allergy?

Most do. Many children outgrow wheat allergy by school age, and around two-thirds by age 12. An allergist can monitor blood or skin tests and arrange a supervised food challenge to check safely.