Wheat Allergy: Everything You Need to Know

Wheat allergy is a rare condition that can be confused with some gastrointestinal diseases. Let's see how you can distinguish it and what its treatment involves.

A wheat allergy refers to the allergic reactions that occur after the ingestion of foods that contain this grain. Reactions usually appear within minutes after contact, although they can also appear 1-3 hours later. Given the context in which it occurs, it can be confused with celiac disease or non-celiac gluten sensitivity.

Wheat allergy is a very difficult condition to diagnose. Some studies suggest that delays of 32 to 62 months are relatively frequent because many allergens that can elicit responses in the body have to be ruled out. Today, we’ll teach you everything you need to know about it, including the symptoms, causes, and how to treat it.

The symptoms of a wheat allergy

Wheat is one of the most widely cultivated grains in the world. It’s present in bread, pizza, cookies, couscous, cakes, biscuits, and hundreds of other foods. Allergic reactions can be manifested in two contexts: Ingestion (food allergy) or inhalation (respiratory allergy). When this happens, the following signs appear:

• Runny nose
• Hives and skin rash
• Sneezing
• Eye irritation
• Nausea and vomiting
• Headaches
• Difficulty breathing

In some cases, the allergy can lead to an anaphylactic reaction. It’s characterized by the confluence of all the above symptoms but in its chronic stages. Anaphylactic shock can cause inflammation of the tongue and airways to the point that it prevents breathing.

All these symptoms can be accompanied by gastrointestinal reactions such as constipation, diarrhea, abdominal pain, flatulence, and others. This is why it’s often confused with celiac disease. However, as Food Allergy Research & Education (FARE) reminds us, they’re different reactions with totally different causes.

The causes of wheat allergy

As we’ve already indicated, a wheat allergy occurs when the patient ingests or inhales a food or product made with this grain. When this happens, the body mistakenly identifies one of the four wheat proteins as a threat.

As a result, it releases antibodies to defend itself from the potential enemy. Specifically, the reactions are caused by the immunoglobulin E antibody (or simply IgE).

This reaction is the same as that of other types of allergies, such as milk, soy, peanuts, or nut allergies. The immune dysregulation process is partly uncertain, although it’s believed that it may be driven by genetic predisposition and environmental factors.

Evidence indicates that it’s much more common in children and that they tend to develop more intense symptoms. Its prevalence varies according to region, although it’s generally between 1% and 3%.

We know that over time, a tolerance to the grain is reached. A study published in the Asian Pacific Journal of Allergy and Immunology in 2017 suggests the following times:

• 2 years of age: 14.7%
• 4 years of age: 27%
• 5 years of age: 45.7%
• 9 years old: 69%

Although considered controversial, there’s no evidence that early wheat exposure or breastfeeding patterns cause allergy according to at least one publication in the Journal of Paediatrics and Child Health in 2017.

The diagnosis of wheat allergy

As we pointed out at the beginning, the diagnosis of a wheat allergy can take several years. The reason for this is that there are multiple conditions that can trigger symptoms.

Other allergens (including, of course, various foods) must be ruled out first, and then illnesses whose symptoms are related.

According to the Children’s Hospital of Philadelphia, the process to diagnose this condition involves the following:

Skin tests

Skin tests are the mainstay for diagnosing any type of allergy. In principle, they involve exposing the skin of the patient to a small amount of wheat. Typically, it’s done on the forearm, and three processes can be chosen for confirmation: Puncture, injection, and patches.

The exposed area is examined for several minutes or even hours. Symptoms characteristic of allergies (such as hives, redness, and swelling) will be looked for. It’s not a 100% accurate test, as it can cause false positives or negatives.

Blood tests

For this test, the patient is exposed to the possible trigger of the reaction (wheat, in this case) and then blood is drawn to assess the presence of IgE produced as an immune response by the body. In turn, blood tests are done to rule out other types of related diseases, such as celiac disease.

Food test

In a controlled environment and with the response alternatives prepared in the event of a complication, the patient is exposed to foods with a high percentage of wheat. The specialist can thus determine the degree of sensitivity and at what concentration chronic symptoms occur.

The use of these tests is generally preferred to make an accurate diagnosis. Depending on the specialist’s suspicion, imaging tests or endoscopies can also be done to rule out other diseases. However, the three listed are the standard for the diagnosis of wheat allergy.

Some possible differential diagnoses that studies have determined are the following:

• Non-IgE-mediated food allergy: Food protein-mediated enterocolitis
• Flushing syndrome: Autonomic epilepsy, carcinoid, chlorpropamide-alcohol
• Restaurant syndromes: Sulfites, scombroid, sodium glutamate
• Non-anaphylactic shock: Cardiac, endotoxic, hemorrhagic
• Syndromes with excessive endogenous histamine production: Urticaria pigmentosa, basophilic leukemia, mastocytosis, idiopathic angioedema
• Others: Munchausen syndrome, anorexia nervosa, constipation, seizures, irritable bowel syndrome

Treatment for wheat allergy

We’ve previously reported that a high percentage of patients diagnosed during childhood develop a tolerance to wheat before the age of 9. While this is happening, the specialist will suggest staying away from the wheat variants that cause more severe reactions. These are determined during diagnostic tests.

Therefore, the treatment consists of totally or partially excluding wheat from the diet. It all depends on the patient’s degree of sensitivity and the chances of developing anaphylaxis. The doctor will also recommend the following:

• Consulting with a nutritionist to devise a plan according to age, height, and daily energy demands
• Avoiding products made with wheat (certain cosmetics and certain personal hygiene products)
• Learning to read the labels to discover the derivatives of this cereal
• Always having an injection of epinephrine on hand if you’re prone to severe symptoms
• Wearing a medical bracelet that warns of the condition.

Sometimes, they’ll prescribe antihistamines, although their intake usually only addresses involuntary exposure to the allergen. The evidence indicates that in general, the prognosis is usually very good, although it’s important to check with a specialist to determine its evolution.