People with a wheat allergy have an abnormal immune system response to at least one of the proteins that exist in wheat. It is one of the most common childhood food allergies, but may affect adults as well. The person with a wheat allergy has developed a specific antibody to a wheat protein, and sometimes more than one.
People with wheat allergies can respond with a variety of possible signs and symptoms, including breathing difficulties, nausea, hives, bloated stomach and an inability to focus. With some people the consumption of wheat and wheat products may result in anaphylaxis - a life-threatening allergic response.
Contents of this article:
What is a wheat allergy?
An allergic reaction to wheat involves IgE (immunoglobulin) antibodies to at least one of the following proteins found in wheat:
- Glutenin (gluten).
Most allergic reactions involve albumin and globulin. Allergy to gliadin and gluten are less common. Gluten allergy is often confused with Celiac disease or some other digestive disorders.
Some people have an allergic reaction when they inhale wheat flour, while others need to eat it in order to experience symptoms. An allergic reaction can occur within minutes or sometimes hours of either consuming or inhaling wheat.
An "allergen" is a substance, usually a protein, that causes a food allergy. Allergens are harmless substances, that is, most people are not affected by them. They are called allergens because some people have an allergy when exposed to them.
Signs and symptoms
A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.
The most common signs and symptoms of a wheat allergy include:
- Allergic rhinitis - nasal congestion
- Atopic dermatitis (eczema)
- Mouth irritation and possible swelling
- Throat irritation and possible swelling
- Urticaria - hives, an itchy rash (possible swelling of the skin)
- Watery and/or itchy eyes
- Bloated stomach.
Signs and symptoms of anaphylaxis may include:
- Throat swells and becomes tight
- Chest tightness
- Chest pain
- More severe breathing difficulties
- Swallowing difficulties
- Skin becomes pale or bluish
- Weak pulse
- Hypotension - a serious drop in blood pressure.
Anaphylaxis is a medical emergency.
Wheat allergies generally develop when the human is a baby or toddler. In most cases the child will also have other food allergies. Generally, children no longer have the allergy after the ages of 3 to 5 years. Wheat allergy does exist among adults, but it is much less common than in children.
What causes wheat allergies?
According to The Anaphylaxis Campaign1, a UK charity meeting the needs of people at risk from severe allergic reactions, a wheat allergy is an immune system response.
Our immune system is designed to protect us from foreign bodies and pathogens (things that cause disease), such as bacteria, viruses, and toxic substances. An allergic reaction occurs when the immune system mistakes a normal or good substance for a pathogen, and attacks it.
Sometimes our immune system may attack good tissues and cells in our bodies; this is called an autoimmune disease. In the cases of wheat allergy, the immune system attacks wheat proteins as if they were, for example, harmful bacteria.
The body of a person who is allergic to wheat produces an antibody to a protein found in wheat, causing an allergy. When the human body has developed an allergy-causing antibody to a specific agent (an allergen), which in this case is a wheat protein, the immune system becomes sensitive to it. Whenever that person eats a protein contained in wheat, their immune system attacks it.
Albumin, globulin, gliadin and gluten are classes of protein in wheat that can cause an allergic response. Some people are allergic to just one of them, while others may be allergic to two or even more.
According to data from Food Allergy Research & Education (FARE)2, the following foods are possible sources of wheat proteins:
- Beer, ale, root beer
- Breakfast cereals
- Cakes and muffins
- Coffee substitutes
- Condiments, such as ketchup
- Dairy products, such as ice cream
- Gelatinized starch
- Gravy (many types)
- Hydrolyzed vegetable protein
- Ice-cream cones
- Instant chocolate drink mixes (many of them)
- Malted milk
- Meat products, such as hotdogs
- Meat, crab or shrimp substitutes
- Modified food starch
- Monosodium glutamate (MSG)
- Natural flavorings
- Noodles, spaghetti, macaroni, and other pasta products prepared with wheat or semolina flour
- Soy sauce
- Vegetable gum
- Worcestershire sauce.
Barley, oats and rye also contain some of the proteins contained in wheat. Therefore, some people may be allergic not just to wheat, but possibly to rye, oats and/or barley too.
Allergic reactions triggered by wheat and exercise
Some people may have allergic symptoms if they do exercise within a few hours of consuming wheat proteins. Experts say that exercise, in some cases, triggers an immune response to wheat proteins. These exercise-induced allergic reactions often lead to anaphylaxis - a life-threatening reaction.
This is a disorder which can affect people who work in bakeries or places with lots of uncooked wheat flour. The allergy is caused by inhaling wheat flour (not eating it). The condition generally affects the patient's breathing. Experts say the allergy may be caused by a wheat protein, or possibly a fungus.
Celiac disease (gluten-sensitive enteropathy)
Celiac disease is classed as a food sensitivity, rather than an allergy. The individual's immune system reacts to gluten, causing inflammation in the small intestine, resulting in poor absorption of nutrients. Some people have both celiac disease and wheat allergy.
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
There are two main risk factors for wheat allergy:
- Family history - if a close relative, such as a parent or sibling has an allergy, a person may have a higher risk of developing wheat allergy. A family history of allergies may include wheat allergy, hay fever, asthma - any allergy.
- Age - infants and toddlers are much more likely to have wheat allergy, compared to other people. Their immune and digestive systems are still immature. The majority of children eventually outgrow their allergy to wheat.
Tests and diagnosis
A GP (general practitioner, primary care physician), qualified nutritionist or immune system specialist will probably use a number of tests, as well as carrying out a physical exam, before being able to make a proper diagnosis - these may include:
- Food diary - the doctor may ask the patient to write down everything they eat and when, as well as detailed notes on symptoms.
- Elimination diet - all suspected foods are eliminated from the patient's diet. After a few days, suspected foods with allergens, which in this case would be wheat, are reintroduced at intervals. With the help of an eating diary, carefully noting down each item consumed and symptoms felt, the patient may identify which particular foods are causing problems. The ultimate aim is to substitute unpleasant foods with others that do not cause an allergic reaction. It is important that this is done with a qualified health care professional.
- Food challenge testing - this is generally done in a hospital or specialized allergy clinic. The patient eats capsules which contain suspected allergens. The patient starts with small doses, which are gradually increased over a period of hours or days. During the whole process the individual is monitored for allergy signs and symptoms.
- Skin-prick test - drops of diluted foods are placed on the patient's arm. The skin is then pierced through the drop, thus introducing the food into the system. If there is itching, redness or swelling, the indication is most likely a positive reaction. Experts say that negative results are 95% accurate, while positive results are 55% accurate.
- Blood test - this test looks for antibodies for specific foods, giving an indication of the likelihood of an allergy to those foods. A blood test may be a good alternative for patients with existing skin conditions or interactions with certain medications - these patients may not be able to do the skin-prick test. Experts say that negative results from a blood test are 95% accurate, while positive results are 55% accurate.
If you have a wheat allergy, the best treatment is to avoid wheat proteins. This is not easy, as wheat appears in so many foods. Even seemingly non-wheat foods require careful label inspection.
This is a type of medication which lowers the patient's immune system, often resulting either in the elimination of allergy symptoms, or a significant reduction. They should be taken after exposure to wheat. It is important to talk to your doctor before taking any antihistamines for wheat allergy.
FARE2 advises people with a wheat allergy to carry an epinephrine auto-infector with them at all times.
This is an emergency treatment for a serious allergic reaction - anaphylaxis. Patients at high risk of anaphylaxis from wheat, or any product, should carry two injectable doses of epinephrine. The medication is administered as an auto-injector pen straight onto the skin.
The pens each contain a single dose of adrenaline which can be injected into the body through a concealed spring-loaded needle - examples include the EpiPen and the Anapen. Adrenaline opens the airways, helping the patient breathe better. It also helps bring severe low blood pressure back up.
Wheat allergy vs. celiac disease
Michael Marcus, MD .. Director Pediatric Allergy & Pulmonary -Maimonides Medical Center, talks about the difference between wheat allergy and celiac disease.