What Is Wheat Allergy?

Wheat allergy can be very severe and even life-threatening at times. Therefore, it is crucial to understand wheat allergy, including the common causes, triggers, symptoms and the best way to manage it. As the name suggests, wheat allergy is an allergic reaction that occurs in some people when exposed to products containing wheat. Wheat allergy normally first occurs during early to late childhood.¹ However, it is manageable over time, and there are certain precautions that can be taken to avoid severe reactions, with the main one being avoiding all products containing wheat. This short but informative article will give a good insight into how to manage wheat allergy, including common symptoms, diagnosis techniques and how to support someone with wheat allergy. 

Introduction

The prevalence of food allergies varies according to geographic areas, with an estimate of 10% and 6.7% of people having food allergies in the US and Canada and 0.3 to 3.4% in Europe (according to the Schär Institute) having a specific allergy to wheat, one of them. The most common food allergies.¹ Wheat allergy is the term used to define an allergic reaction caused after exposure to wheat or a product containing wheat, including bread wheat. Although bread wheat has many nutritional benefits, there are some people who have allergic reactions after consuming or inhaling it.  This is because of an immune-mediated food allergen known as immunoglobulin E (IgE), and people with wheat allergies can either have IgE-mediated or non-IgE-mediated immune responses, also known as coeliac disease. The prevalence of an allergic reaction to wheat alone is estimated to range from 0.2 to 1%, with children having a higher prevalence. Nevertheless, it is estimated that by the age of 12, most children (65%) will outgrow their allergies. If in doubt as to whether you suffer from wheat allergies, it is always best to look for key symptoms associated with wheat allergies or consult a healthcare professional who will test for wheat allergy in a controlled environment. One of the common checks that can be done by a healthcare professional is a skin prick test.²

Causes and triggers

Common wheat allergy triggers

As suggested by the name, the main trigger for wheat allergies is products containing wheat, with the most common product being bread wheat, but also including:

• Breads
• Pasta
• Pizza
• Bulgur wheat
• Couscous
• Drinks such as beer
• Dairy products³

The immune system's response to wheat proteins

There are two types of wheat allergies known as IgE-mediated or non-IgE-mediated responses. IgE-mediated responses refer to the reaction of an antibody protein called Immunoglobulin E (IgE). This contrasts with non-IgE-mediated responses, which refer to an allergic reaction, often associated with coeliac disease, an autoimmune disorder. This reaction is caused due to a delayed immune response response to another chemical known as gluten, which is also found in wheat (and other cereals like barley). In general, a wheat-free diet is less restrictive compared to a gluten-free diet. Therefore, it is advisable to check the type of allergy before making drastic changes to lifestyle. In both cases, the immune system will view the protein, including IgE or gluten, as foreign and ‘attack’ it, causing an immune response and the symptoms associated with wheat allergy.³

Symptoms

There are some symptoms which can manifest after exposure to wheat, which may start 2 hours post-wheat exposure. These include:

• Urticaria – Also known by its more common name of hives, urticaria is a skin condition referring to the itchy red bumps often associated with allergic reactions.
• Angioedema – Normally associated with urticaria, angioedema refers to the swelling of the skin around the eyes and lips
• Asthma – Asthma is a chronic respiratory condition resulting in difficulty breathing, wheezing and coughing
• Allergic rhinitis – Known by its more common name of Hay Fever, allergic rhinitis induces symptoms including sneezing and runny and stuffy noses. 
• Abdominal pain – Pain in the lower chest area between the chest and the pelvis
• Vomiting – Vomiting is normally a protective reflex against irritants, infections and other digestive problems
• Acute exacerbation of atopic dermatitis – Acute exacerbation refers to the worsening of atopic dermatitis, a chronic skin condition that causes itchy and inflamed skin.³

Anaphylaxis is a severe reaction

Wheat allergies can be life-threatening and cause a condition known as anaphylaxis. Some of the most common symptoms of anaphylaxis include:

• Tightening and swelling of the throat
• Pain in the chest
• Difficulty breathing
• Pale, blue skin colour
• Dizziness or fainting²

Complications

There are many complications that can arise due to wheat allergy, especially the non-IgE-mediated response commonly known as coeliac disease. Some of the complications include:

• Anaemia
• Anxiety
• Arthralgia
• Arthritis
• Delayed puberty
• Depression
• Fatigue
• Pancreatitis
• Short stature²

Diagnosis

After exhibiting any of the signals or symptoms associated with wheat allergy, the best way to get diagnosed is by visiting a healthcare professional who will be able to conduct further testing to identify the aetiology of the symptoms. Some of the common tests that can be conducted by the healthcare professional include skin or blood testing or, in very severe cases, advice and guidance towards treatment options, including immunotherapy.² Furthermore, a healthcare professional may ask about medical history or family history as coeliac disease can be genetic in origin.³

Elimination diets and food challenges

In addition, while consulting a healthcare professional who will aid in the diagnosis and treatment of the condition, it is also essential to seek help from a nutritionist. A professional nutritionist will easily be able to advise you on what to eat daily and the best options to avoid wheat and wheat-related products. Because there is currently no cure for wheat allergies, avoiding products containing wheat is currently the best option.² 

Management and treatment

Wheat avoidance strategies

There is currently no cure for wheat allergies, meaning that the best way to avoid a reaction and unwanted side effects is to avoid eating products containing wheat. However, this is not always easy as some products, including ice cream, hotdogs and even beer, may have traces of wheat, including gluten and IgE proteins.²  Therefore, it is always advisable to read labels before consuming anything from the supermarket and also talk to restaurant staff to be extra careful when dealing with products containing gluten or wheat. In addition, it is important to be aware that eating wheat products is not the only way of getting it into the body and inhaling wheat flour can also an allergic reaction. 

Treatment 

Nevertheless, if a person with allergies is exposed to foods containing wheat or gluten, adrenaline can be a life-saving treatment, especially in someone prone to anaphylaxis. Adrenaline is an injection available in 0.15 or 0.3mg that is normally injected into the l thigh. It is always advisable to carry some form of adrenaline, like the EpiPen, if you have allergic reactions and a medical bracelet with instructions on the best way to handle these situations. Following adrenaline injections, patients should go to accident and emergency for further evaluation.² Other treatment options for people suffering from wheat allergy include:

• Oral immunotherapy (OIT)
• Sublingual immunotherapy (SLIT)
• Epicutaneous immunotherapy (EPIT)² 

Living with a wheat allergy

Living with wheat allergy can be extremely hard as it involves drastic changes to your lifestyle, not just physically but also mentally. When experiencing wheat allergy, it is easy to feel isolated, especially when everyone around you is eating something you can’t eat. It can also feel a bit overwhelming to have to constantly think about everything and read every ingredient before eating/buying things from the supermarket. Therefore, it is essential to have a strong support group by talking to friends and family. Alternatively, if you know someone suffering from wheat allergy, it is important to remember to always be kind and supportive. Some of the nice things to do for someone suffering from a wheat allergy include reading labels, talking to restaurant staff on their behalf, and cooking using only gluten-free products or products that do not contain wheat.  

Summary

In conclusion, wheat allergy refers to an allergic reaction due to exposure to wheat-related products, including bread, wheat, pizza, pasta and some dairy products. There are two main types of wheat allergies, known as IgE-mediated and non-IgE-mediated reactions. The IgE-mediated allergic reaction refers to the immune system attacking and not recognising the protein IgE found in wheat. Alternatively, the latter non-IgE-mediated reaction refers to an allergic reaction against gluten, and it is often known as coeliac disease. 

The symptoms for both types of allergic reactions vary, and some of the most common symptoms include urticaria, asthma, abdominal pain and feeling faint. In some cases, it may even lead to anaphylaxis. Therefore, it is essential to consult a healthcare professional as soon as possible if experiencing any of these signs or symptoms. The best treatment for wheat allergy is to avoid it, considering there is no current cure for wheat allergy. However, if exposed to wheat-containing products, an adrenaline injection can be given. Furthermore, the best way to live with wheat allergy is to rely on your loved ones.