Managing a wheat allergy — your own or someone else’s — includes strict avoidance of wheat ingredients in both food and nonfood products.
Wheat is one of eight allergens with specific labeling requirements under the Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004. Under that law, manufacturers of packaged food products sold in the U.S. and containing wheat as an ingredient must include the presence of wheat, in clear language, on the ingredient label.
The grain is found in a myriad of foods — cereals, pastas, crackers and even some hot dogs, sauces and ice cream. It is also found in nonfood items such as Play-Doh, as well as in cosmetic and bath products. Note that the FALCPA labeling rules do not apply to nonfood items; if you have questions about ingredients in those products, check the manufacturer’s website or contact the company.
Foods that don’t contain wheat as an ingredient can be contaminated by wheat in the manufacturing process or during food preparation. As a result, people with a wheat allergy should also avoid products that bear precautionary statements on the label, such as “made on shared equipment with wheat,” “packaged in a plant that also processes wheat” or similar language. The use of those advisory labels is voluntary, and not all manufacturers do so.
A challenging aspect of managing a wheat allergy is baking. While there’s no simple substitution for wheat as an ingredient, baked goods such as breads, muffins and cakes may be made using a combination of non-wheat flours, such as those made from rice, corn, sorghum, soy, tapioca or potato starch. Your allergist can provide you with guidance on which grains are safe for you.
Options for wheat-free grocery shopping include foods made from other grains such as corn, rice, quinoa, oats, rye and barley.
The recent growth in gluten-free products is making it easier to manage a wheat allergy. Gluten is a protein found in wheat, barley and rye.
A gluten-free product may be safe for those who are allergic to wheat because the product should not contain wheat ingredients. However, because a product marketed as “gluten-free” must also be free of rye and barley in addition to wheat, those who must avoid only wheat may be limiting themselves. Anyone managing a food allergy shouldn’t rely on a “free from” label as a substitute for thoroughly reading the complete ingredient label.
People with any kind of food allergy must make some changes in the foods they eat. Your allergist can direct you to helpful resources, such as special cookbooks, patient support groups and registered dietitians, who can help you plan your meals.
Managing a severe food reaction with epinephrine
A wheat allergy reaction can cause symptoms that range from mild to life-threatening; the severity of each reaction is unpredictable. People who have previously experienced only mild symptoms may suddenly experience a life-threatening reaction known as anaphylaxis. In the U.S., food allergy is the leading cause of anaphylaxis outside the hospital setting.
Epinephrine (adrenaline) is the first-line treatment for anaphylaxis, which can occur within seconds or minutes, can worsen quickly and can be deadly. In this type of allergic reaction, exposure to the allergen causes the whole-body release of a flood of chemicals that can lead to lowered blood pressure and narrowed airways, among other serious symptoms.
Once you’re diagnosed with a food allergy, your allergist will likely prescribe an epinephrine auto-injector and teach you how to use it. Check the expiration date of your auto-injector, note the expiration date on your calendar and ask your pharmacy about reminder services for prescription renewals.
Be sure to have two doses available, as the severe reaction may recur. If you have had a history of severe reactions, take epinephrine as soon as you suspect you have eaten an allergy-causing food or if you feel a reaction starting. Epinephrine should be used immediately if you experience severe symptoms such as shortness of breath, repetitive coughing, weak pulse, generalized hives, tightness in the throat, trouble breathing or swallowing, or a combination of symptoms from different body areas such as hives, rashes or swelling coupled with vomiting, diarrhea or abdominal pain. Repeated doses of epinephrine may be necessary.
If you are uncertain whether a reaction warrants epinephrine, use it right away, because the benefits of epinephrine far outweigh the risk that a dose may not have been necessary.
Common side effects of epinephrine may include anxiety, restlessness, dizziness and shakiness. Rarely, the medication can lead to abnormal heart rate or rhythm, heart attack, a sharp increase in blood pressure, and fluid buildup in the lungs. Patients with certain pre-existing conditions, such as diabetes or heart disease, may be at higher risk for adverse effects and should speak to their allergist about using epinephrine.
Your allergist will provide you with a written emergency treatment plan that outlines which medications should be administered and when (note that between 10 and 20 percent of life-threatening severe allergic reactions have no skin symptoms). Be sure that you understand how to properly and promptly use an epinephrine auto-injector.
Once epinephrine has been administered, immediately call 911 and inform the dispatcher that epinephrine was given and that more may be needed from the emergency responders.
Other medications, such as antihistamine and corticosteroids, may be prescribed to treat symptoms of a food allergy, but it is important to note that there is no substitute for epinephrine — this is the only medication that can reverse the life-threatening symptoms of anaphylaxis.
Managing food allergies in children
Because fatal and near-fatal wheat allergy reactions, like other food allergy symptoms, can develop when a child is not with his or her family, parents need to make sure that their child’s school, day care or other program has a written emergency action plan with instructions on preventing, recognizing and managing these episodes in class and during activities such as sporting events and field trips. A nonprofit group, Food Allergy Research & Education, has a list of resources for schools, parents and students in managing food allergies.
If your child has been prescribed an auto-injector, be sure that you and those responsible for supervising your child understand how to use it.
Wheat allergy vs. celiac disease
Wheat allergy and celiac disease are similar in some respects, but not identical.
Celiac disease (also called celiac sprue) is caused by an abnormal immune reaction to gluten in the small intestine. Gluten is a protein found in various grains. When individuals with celiac disease eat gluten-containing products such as barley, rye and wheat, damage occurs in the lining of the small intestine. People typically experience symptoms such as abdominal pain, bloating or diarrhea and may be at risk for malnutrition and other complications, such as osteoporosis and anemia.
Celiac disease is both a food intolerance and an autoimmune disorder. Researchers estimate that about 1 percent of the U.S. population has celiac disease.
By contrast, a wheat allergy is an overreaction of the immune system specifically to wheat protein. When a person with wheat allergy is exposed to wheat protein, it can trigger an allergic reaction that may result in a range of symptoms such as a skin rash, itching, swelling, trouble breathing, wheezing and loss of consciousness.