Wheat

Symptoms

While the symptoms of a wheat allergy are usually mild, in some cases they may be severe and can be deadly, making a diagnosis and appropriate management of the allergy imperative.

Wheat allergy is most common in children; about two-thirds of them outgrow it at a relatively young age. Though many patients with wheat allergy can eat other grains, that’s not true for everyone. Talk with your allergist about what you can safely eat and what you should avoid, so you and your children can live the lives you want.

Generally, you are at greater risk for developing an allergy to any food, including wheat, if you come from a family in which allergies or allergic diseases, such as asthma or eczema, are common. If both of your parents have allergies, you’re more likely to develop a food allergy than someone with only one parent who has allergies.

Wheat allergy is typically outgrown by adulthood — about 65 percent of children with a wheat allergy will outgrow it by the time they are 12.

As with reactions to other foods, the symptoms of a wheat allergy may include:

• Hives or skin rash
• Nausea, stomach cramps, indigestion, vomiting or diarrhea
• Stuffy or runny nose
• Sneezing
• Headaches
• Asthma
• Anaphylaxis (less common), a potentially life-threatening reaction that can impair breathing and send the body into shock

Symptoms may range from mild to severe. If you experience any of these reactions after exposure to something containing wheat, see an allergist.

Diagnosis

Some indications of an allergy to wheat — stomach cramps, diarrhea and other gastrointestinal symptoms — overlap with those produced by a sensitivity to gluten or by celiac disease, an autoimmune disorder, so it’s crucial to get an accurate diagnosis. An allergist can determine whether an allergy is present.

Your allergist will first take a medical history, asking particularly about other family members with allergies or allergic diseases, such as asthma or eczema. If both of your parents have food allergies, you’re more likely to have them as well.

Diagnosis of an allergy can be made through a skin-prick test or a blood test.

In the skin-prick test, a small amount of a liquid containing wheat protein is placed on the back or forearm, which is then pricked with a small, sterile probe to allow the liquid to seep into the skin. If a raised, reddish spot forms within 15 to 20 minutes, that can indicate an allergy.

In the blood test, a blood sample is sent to a laboratory to test for the presence of immunoglobulin E antibodies to wheat protein. The results are reported as a numerical value. A blood test that looks for different antibodies can be used to screen for celiac disease.

If these tests aren’t definitive, your allergist may order an oral food challenge. Under medical supervision, you’ll eat small amounts of wheat to see if a reaction develops. Because of the possibility that a reaction could be severe, this test is conducted in your allergist’s office or at a food challenge center with emergency equipment and medication on hand.

Management and Treatment

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, 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 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. Allergists are specially trained to 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.

Gluten “Allergy”

Gluten is a protein found in grains, such as wheat, barley and rye. Some people are allergic to wheat, but that is not the same as a gluten allergy. Gluten allergy is a misleading term commonly confused with wheat allergy, or sometimes celiac disease. There is no such thing as a gluten allergy, but there is a condition called Celiac Disease. Celiac Disease is a digestive condition that is potentially serious if not diagnosed or treated.  Symptoms of celiac disease include severe diarrhea after eating gluten-containing products, a rash, severe weight loss or failure to properly gain weight, and abdominal pain.  In small children, you may only see poor weight gain and no pain, or other symptoms.  Diagnosis of celiac disease can only be made by a board-certified gastroenterologist.  It must also be made when the person is eating foods with gluten, as gluten avoidance is the active treatment.

A gluten intolerance is not an allergy, and there are currently no tests for accurate diagnosis. People with certain symptoms might need to be tested for celiac disease, but few people with gluten intolerance have celiac disease. Gluten intolerance is not an indication for allergy testing and is not a condition where an allergist could offer help. There are many people who label themselves as “allergic” to gluten, and unfortunately limit their diet without having seen a specialist.  People with gluten intolerance should be seen by their primary care provider or referred to a gastroenterologist if there is concern about celiac disease.

If you need more answers about a possible wheat allergy, then it’s time to see an allergist.