Wheat Allergy

Overview

Wheat allergy is an allergic reaction to foods containing wheat. Allergic reactions can be caused by eating wheat and also, in some cases, by inhaling wheat flour.

Avoiding wheat is the primary treatment for wheat allergy, but that isn't always as easy as it sounds. Wheat is found in many foods, including some you might not suspect, such as soy sauce, ice cream and hot dogs. Medications may be necessary to manage allergic reactions if you accidentally eat wheat.

Wheat allergy sometimes is confused with celiac disease, but these conditions differ. Wheat allergy occurs when your body produces antibodies to proteins found in wheat. In celiac disease, a specific protein in wheat — gluten — causes a different kind of abnormal immune system reaction.

Symptoms

A child or adult with wheat allergy is likely to develop signs and symptoms within minutes to hours after eating something containing wheat. Wheat allergy signs and symptoms include:

• Swelling, itching or irritation of the mouth or throat
• Hives, itchy rash or swelling of the skin
• Nasal congestion
• Headache
• Difficulty breathing
• Cramps, nausea or vomiting
• Diarrhea
• Anaphylaxis

Anaphylaxis

For some people, wheat allergy may cause a life-threatening reaction called anaphylaxis. In addition to other signs and symptoms of wheat allergy, anaphylaxis may cause:

• Swelling or tightness of the throat
• Chest pain or tightness
• Severe difficulty breathing
• Trouble swallowing
• Pale, blue skin color
• Dizziness or fainting

When to see a doctor

If someone shows signs of anaphylaxis, call 911 or your local emergency number. Anaphylaxis is a medical emergency that requires immediate care.

If you suspect that you or your child is allergic to wheat or another food, see your doctor.

Causes

If you have wheat allergy, exposure to a wheat protein primes your immune system for an allergic reaction. You can develop an allergy to any of the four classes of wheat proteins — albumin, globulin, gliadin and gluten.

Sources of wheat proteins

Some sources of wheat proteins are obvious, such as bread, but all wheat proteins — and gluten in particular — can be found in many prepared foods and even in some cosmetics, bath products and play dough. Foods that may include wheat proteins include:

• Breads and bread crumbs
• Cakes, muffins and cookies
• Breakfast cereals
• Pasta
• Couscous
• Farina
• Semolina
• Spelt
• Crackers
• Hydrolyzed vegetable protein
• Soy sauce
• Meat products, such as hot dogs
• Dairy products, such as ice cream
• Natural flavorings
• Gelatinized starch
• Modified food starch
• Vegetable gum

If you have wheat allergy, it's possible you might also be allergic to barley, oats and rye. Unless you're allergic to grains other than wheat, though, the recommended wheat-free diet is less restrictive than a gluten-free diet.

Wheat-dependent, exercise-induced anaphylaxis

Some people with wheat allergy develop symptoms only if they exercise within a few hours after eating wheat. Exercise-induced changes in your body either trigger an allergic reaction or worsen an immune system response to a wheat protein. This condition usually results in life-threatening anaphylaxis.

Risk factors

Certain factors may put you at greater risk of developing wheat allergy:

• Family history. You're at increased risk of allergy to wheat or other foods if your parents have food allergies or other allergies, such as asthma.
• Age. Wheat allergy is most common in babies and toddlers, who have immature immune and digestive systems. Most children outgrow wheat allergy by 16, but adults can develop it, often as a cross-sensitivity to grass pollen.

Diagnosis

A physical exam, detailed medical history and some tests will help your doctor make a diagnosis. Tests or diagnostic tools may include:

• Skin test. Tiny drops of purified allergen extracts — including extracts for wheat proteins — are pricked onto your skin's surface, either on your forearm or on your upper back. After 15 minutes, your doctor or nurse looks for signs of allergic reactions.

  If you develop a red, itchy bump where the wheat protein extract was pricked onto your skin, you may be allergic to wheat. The most common side effect of these skin tests is itching and redness.

• Blood test. If a skin condition or possible interactions with certain medications prevent you from having a skin test, your doctor may order a blood test that screens for specific allergy-causing antibodies to common allergens, including wheat proteins.
• Food diary. Your doctor may ask you to keep a detailed record of what and when you eat and when symptoms develop for a time.
• Elimination diet. Your doctor may recommend that you remove certain foods from your diet, particularly those that are common allergens. Under your doctor's direction, you will gradually add foods back and note when symptoms return.
• Food challenge testing. You eat food suspected of being the allergy-causing agent while being monitored for allergy symptoms. Under supervision, you begin with a small amount of the food and gradually increase the amount you consume.

Treatment

Avoiding wheat proteins is the best treatment for wheat allergy. Because wheat proteins appear in so many prepared foods, read product labels carefully.

Drugs

• Antihistamines may reduce signs and symptoms of minor wheat allergy. These drugs can be taken after exposure to wheat to control your reaction and help relieve discomfort. Ask your doctor if a prescription or an over-the-counter allergy drug is appropriate for you.
• Epinephrine is an emergency treatment for anaphylaxis. If you're at risk of having a severe reaction to wheat, you may need to carry two injectable doses of epinephrine (EpiPen, Adrenaclick, others) with you at all times. A second pen is recommended for people at high risk of life-threatening anaphylaxis in case anaphylactic symptoms return before emergency care is available.

Emergency care

Emergency medical care is essential for anyone who has an anaphylactic reaction to wheat, even after receiving an injection of epinephrine. Call 911 or your local emergency number as soon as possible.

Potential future treatments

Scientists are working on several types of immunotherapy to treat food allergies. Immunotherapy exposes you to small amounts of the allergic substance and then increases that exposure over time. The hope is that your body will become desensitized to the allergen, and you'll have fewer or no symptoms.

Several small clinical trials have been done on an oral form of immunotherapy for wheat allergy that showed reduced allergy symptoms. More research is needed, however.

Self care

You can take steps to avoid exposure to wheat proteins and ensure prompt treatment when you're accidentally exposed to wheat.

• Keep others informed. If your child has wheat allergy, make sure that anyone who takes care of your child, including the principal, teachers and nurse at school or child care, knows about the allergy and the signs of wheat exposure. If your child carries epinephrine, make sure school personnel know how to use the pen, if necessary, and that they need to contact emergency care immediately. Inform friends, relatives and co-workers of your own food allergy.
• Wear a bracelet. A medical identification bracelet that describes the allergy and need for emergency care can help if you experience anaphylaxis and can't communicate.
• Always read labels. Don't trust that a product is free of what you can't eat until you read the label. Wheat proteins, especially gluten, are used as food thickeners, and they appear in many unexpected places. Also, don't assume that once you've used a certain brand of a product, it will always be safe. Ingredients change.
• Shop for gluten-free foods. Some specialty stores and supermarkets offer gluten-free foods, which are safe for people with wheat allergies. However, they may also be free of grains that you can eat, so sticking to gluten-free foods may limit your diet needlessly.
• Consult wheat-free cookbooks. Cookbooks specializing in recipes without wheat can help you cook safely and enable you to enjoy baked goods and other foods made with substitutes for wheat.
• Dine out cautiously. Tell restaurant staff about your allergy and how serious it can be if you eat anything with wheat. Ask staff how meals are prepared, and order simple dishes made with fresh foods. Avoid foods such as sauces that may have hidden sources of wheat proteins.

Preparing for your appointment

See your doctor if you suspect that you or your child has wheat allergy or another allergy. The doctor may refer you to a specialist in allergies (allergist) for some diagnostic tests.

What you can do

To prepare for your appointment, make a list for your doctor that includes:

• Symptoms, including any that may seem unrelated to an allergy
• Your family's history of allergy and asthma, including specific types of allergies
• Medications, vitamins or supplements you or your child is taking

Also list questions to ask your doctor, such as:

• Are these symptoms likely due to an allergy?
• Will I need allergy tests?
• Should I see an allergist?
• Do I need to carry epinephrine in case of anaphylaxis?
• Do you have brochures or other printed material? What websites do you recommend for more information?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• How soon after eating do symptoms appear?
• Do symptoms seem to be related to a specific food?
• For an infant, what solid foods does your baby eat?
• Have you recently introduced a new food to your baby's diet?
• Did anyone else get sick from eating the same food?
• How much of a suspected allergy-causing food was eaten?
• What other foods were eaten at or around the same time?