Wheat is a staple food for billions of people worldwide, playing a vital role in many diets. However, for some individuals, consuming wheat can trigger adverse reactions due to wheat allergy.
When someone with wheat allergy is exposed to wheat proteins, their immune system perceives them as harmful invaders and produces antibodies, specifically immunoglobulin E (IgE), to combat them.
Typically, your risk of developing an allergy to any food, including wheat, increases if you have a family history of food allergies or allergic conditions like hay fever, asthma or eczema. If both your parents have allergies, your likelihood of developing a food allergy is higher than if only one of your parents has allergies.
What are the signs of wheat allergy?
Exposure to wheat can manifest with a diverse array of symptoms, and the severity of these symptoms can differ from person to person. Symptoms of wheat allergy include:
- Skin Reactions: Hives, itching, eczema, and swelling are typical skin manifestations of wheat allergy.
- Respiratory Symptoms: Wheezing, coughing, sneezing, and nasal congestion may occur, resembling symptoms of hay fever or allergic rhinitis.
- Gastrointestinal Issues: Nausea, vomiting, abdominal pain, and diarrhoea can develop after consuming wheat-containing foods.
- Anaphylaxis: In severe cases, wheat allergy can lead to anaphylaxis, a life-threatening allergic reaction characterised by difficulty breathing, a drop in blood pressure, and loss of consciousness. Immediate medical attention is crucial in such serious symptoms.
- Asthma Exacerbation: People with wheat allergy who also have asthma may experience worsened asthma symptoms when exposed to wheat allergens.
- Other Allergic Symptoms: Symptoms like itchy or watery eyes, sneezing, and an itchy throat are also possible.
What are the types of wheat allergy?
IgE-mediated (immediate allergy)
This specific reaction occurs due to the body generating IgE antibodies in response to one or more proteins present in wheat grains. Allergic responses to wheat and similar cereals (e.g. barley and rye) are typically more prevalent in children, but adults can also develop wheat allergies.
Symptoms of IgE-mediated wheat allergy can manifest anywhere from minutes to up to two hours after consumption and may encompass symptoms such as rhinitis, asthma, hives (urticaria), swelling (angioedema), or even anaphylaxis. These are commonly referred to as the ABC symptoms and can manifest as follows:
- AIRWAY – Swelling in the throat, tongue, or upper airways, leading to symptoms such as throat constriction, hoarseness, and difficulty swallowing.
- BREATHING – Sudden onset of wheezing, breathing difficulties, or noisy breathing.
- CIRCULATION – Experiencing dizziness, feeling faint, sudden sleepiness, extreme tiredness, confusion, pale and clammy skin, and loss of consciousness.
Additionally, individuals may experience vomiting, diarrhoea, abdominal discomfort.
Non-IgE-mediated (delayed allergy)
Non-IgE-mediated reactions can manifest anywhere from several hours to several days after wheat consumption, resulting in symptoms like diarrhoea, nappy rash or a worsening of eczema. Regrettably, skin prick tests are not effective in identifying this type of reaction, but patch testing to wheat may be helpful.
The gold standard for diagnosis is a combination of assessing the patient’s symptom history and conducting a trial of wheat (plus gluten) exclusion and subsequent reintroduction. Since wheat is a significant component of most people’s diet, it’s crucial to undertake such an approach under the guidance and supervision of an experienced dietitian.
Intolerance sets itself apart from IgE and non-IgE mediated allergies because it does not trigger an immune system response. A significant number of individuals encounter symptoms akin to irritable bowel syndrome (IBS) after consuming wheat, including bloating, flatulence, abdominal rumbling, and discomfort.
These symptoms can often be attributed to the high concentration of fructans, a type of fermentable carbohydrate, found in wheat, barley, and rye. These poorly absorbed fructans ferment in the large intestine, leading to the development of symptoms.
For individuals dealing with IBS or gut fermentation, it is advisable to seek the expertise of a specialised dietitian who can provide guidance on implementing the Low FODMAP diet approach.
Coeliac Disease (an autoimmune reaction)
Coeliac disease should not be confused with an allergy or intolerance; rather, it is an autoimmune condition triggered by the presence of gluten proteins, which can be found in wheat, rye, and barley. This immune reaction results in damage to the lining of the small intestine, leading to impaired nutrient absorption and the potential for nutritional deficiencies.
While some individuals with coeliac disease may not exhibit any symptoms (asymptomatic), others may experience a range of distressing symptoms, including bloating, diarrhoea, nausea, flatulence, constipation, fatigue, unexplained weight loss, hair loss, joint or bone pain, tingling sensations, infertility, recurrent miscarriages, and anaemia. Additionally, a subset of individuals with coeliac disease may also develop a skin condition known as “dermatitis herpetiformis,” although this is less common.
The diagnosis of coeliac disease typically involves blood tests and/or a biopsy of the intestinal lining. For dermatitis herpetiformis, a skin biopsy is performed. It’s important to note that for these tests to yield accurate results, gluten consumption must be a regular and daily part of the diet for at least six weeks before testing.
Gluten sensitivity shares similarities with coeliac disease in terms of symptom presentation, but the exact involvement of the immune system remains unclear. This condition is relatively new, and whether it is a lifelong condition or a temporary one remains uncertain.
Individuals frequently report a combination of symptoms when consuming wheat, including abdominal discomfort, changes in bowel habits, bloating, nausea, and acid reflux.
However, gluten sensitivity can also manifest with symptoms beyond gastrointestinal issues, such as cognitive fogginess, joint pains, fatigue, depression, headaches, anxiety, and an overall sense of unwellness.
Currently, there are no specific tests for diagnosing gluten sensitivity. Diagnosis is primarily based on the exclusion of coeliac disease and wheat allergy. A diagnostic approach involves eliminating wheat from the diet to observe if symptoms improve, followed by reintroducing wheat to assess if symptoms recur. For proper guidance on dietary management, patients are advised to consult with a specialist dietitian.
Wheat-Dependent Exercise-Induced Anaphylaxis
Certain individuals may only exhibit wheat allergy reactions when they engage in physical activity after consuming it. These reactions can be quite severe and are recognised as ‘wheat-dependent exercise-induced anaphylaxis.’
Additionally, inhaling wheat flour can lead to wheat allergy symptoms resembling asthma, commonly referred to as ‘Baker’s asthma.’
Diagnosing with of these conditions typically involves a combination of evaluating the patient’s medical history and conducting skin prick tests and/or specific IgE blood tests. In some cases, more specialised wheat allergy tests might be required. It’s important to note that the interpretation of these tests should be carried out by a healthcare professional with the appropriate expertise.
Testing and Diagnosing wheat allergy
If you suspect that you might have a wheat allergy, it’s advisable to schedule an appointment with your GP. They can facilitate a referral to a specialised allergy clinic if necessary. You can also locate a clinic in your vicinity through the British Society for Allergy and Clinical Immunology (BSACI).
In cases where your symptoms do not manifest immediately after wheat consumption, consider asking your GP for a referral to a dietitian. These professionals can assess whether complete wheat avoidance is required or if consuming small quantities is permissible.
Upon referral to an allergy clinic, the consultant will engage in a comprehensive discussion regarding your medical history and symptomatology. To aid in the diagnosis and assessment of the allergy’s severity, they may propose a range of tests, including skin prick tests, blood tests, and food challenge tests.
What is the treatment for wheat allergy?
If you experience mild allergic symptoms, your healthcare provider may prescribe oral antihistamines. However, if you are at a higher risk of anaphylaxis, they may prescribe adrenaline for emergency use.
Adrenaline is available in preloaded adrenaline autoinjectors designed for easy administration. It’s crucial to familiarise yourself with how and when to use them. Always carry two adrenaline autoinjectors with you at all times, as you may need to use a second one if your symptoms do not improve within five minutes or if they worsen.
For full guidance on the correct usage and timing of the adrenaline autoinjector, it is recommended to seek advice from your general practitioner (GP) or allergist. Additionally, valuable information can be found on the manufacturer’s website linked to your specific injector, or you may also refer to organisations like Allergy UK or Anaphylaxis UK for helpful resources.
How do you overcome a wheat allergy?
Wheat allergy is most prevalent among children and often tends to be outgrown during the preschool years. If your child has an immediate wheat allergy, it is crucial to ensure regular check-ups with their allergy clinic. It is strongly advised not to attempt wheat reintroduction into your child’s diet at home without seeking guidance from an allergy specialist, even if you suspect they may have outgrown their allergy.
It is crucial to initiate the process by seeking advice from your GP if you suspect a reaction to wheat before making any dietary changes. Subsequent referral to a healthcare professional with expertise in the field can facilitate further testing and provide appropriate dietary recommendations.
Some individuals may also exhibit reactions to other grains like rye and barley, which share similar proteins with wheat. Your physician or dietitian can provide guidance on whether it’s necessary to avoid these grains in addition to oats.
After receiving a diagnosis of immediate wheat allergy, it becomes crucial to adopt a strict wheat-free diet and abstain from foods containing wheat. It’s essential to read ingredient lists consistently because manufacturers frequently modify their recipes.
Exercise diligence when shopping by carefully scrutinising ingredient lists on food packaging each time you make a purchase. In the UK, wheat (along with other gluten-containing cereals) is classified as one of the top 14 major food allergens. Consequently, it should be clearly highlighted on ingredients labels, often in bold.
Eateries, including restaurants, cafes, hotels, takeaways, and catering establishments, are legally obligated to provide information about major allergens, including wheat. When dining out, don’t hesitate to inquire with the staff whether the food you intend to order contains wheat and if there is a risk of cross-contamination. Be sure to convey that even minimal quantities of wheat can trigger an allergic reaction, and feel free to request that the staff consult with the chef for added assurance.
To find out more about wheat allergy download the Anaphylaxis UK’s Fact Sheet PDF.
How can we help at Children’s Allergy Doctors?
At Children’s Allergy Doctors, we offer a comprehensive array of allergy services for various allergy-related conditions. Our commitment is to accompany you through every stage of your journey, from the initial allergy diagnosis to assisting you with the management of food allergies and beyond.
We offer food allergy desensitisation. Wheat allergy treatments come in the form of an OIT programme designed to give increasing amounts of wheat to your child. The aim of the treatment is to help prevent accidental reactions to wheat. It is not a cure for wheat allergy but may help expedite the resolution of wheat allergy.
We provide a food allergy desensitisation program for wheat allergies. Our Wheat OIT (Oral Immunotherapy) program involves gradually administering increasing quantities of wheat to your child. The primary goal of this treatment is to reduce the risk of accidental wheat allergy reactions. It’s important to note that this treatment is not a complete cure for wheat allergies, but it may assist in speeding up the resolution of the allergy over time.
Throughout the program, both you and your child will receive counselling and attend scheduled appointments at a clinic led by a consultant. The consideration of suitability for Oral Immunotherapy (OIT) will be integrated into your child’s routine appointment, typically when an allergy diagnosis is established.
If your child is suitable for OIT and you wish to progress, we will provide a tailored plan for this treatment. The plan would typically include a total of 8-14 visits, including an initial visit where the first dose of allergen will be given.
If you would like to find out more about wheat allergy or any other aspect of children’s allergies, or book an appointment, please contact our practice team on 0203 146 7721 or email firstname.lastname@example.org.