Food Allergy & Anaphylaxis

Wheat 

Wheat allergy affects approximately 0.5 percent of children and up to 1.2 percent of adults in the United States. This may manifest as allergy to wheat grain, flour, beer, malted products, cereal grains, occupational-related asthma (asthma provoked by inhalation of wheat produce in industrial settings, often called “baker’s asthma”), or as a food-dependent but exercise-induced reaction to wheat.

Wheat allergens are highly cross-reactive with other grains and grass pollen. This may, from time to time, cause wheat allergic persons to have positive allergy testing to multiple other grains, though they can eat these grains without any symptoms. Gliadin and gluteiin are the major wheat allergens associated with IgE-mediated allergy.

Wheat allergy may be confused with Celiac disease, especially since both involve a reaction to gluten. However, Celiac disease is not the same thing as IgE-mediated wheat allergy. Celiac disease is an auto-immune disease of the gut involving IgA and IgG antibodies that form against gliadin but does not involve mast cells or IgE (i.e., non-IgE mediated allergy), and results in symptoms such as intestinal malabsorption, greasy, smelly diarrhea; abdominal pain; and bloating. In contrast, wheat allergy involves an IgE mediated reaction to gliadin and several other wheat proteins, which can trigger anaphylaxis and other allergic symptoms. Unlike in a wheat allergy, those with Celiac disease need to avoid rye, barley, and gluten-containing oat in addition to wheat. Therefore, gluten-free foods are safe for someone with wheat allergy, but wheat-free foods may not be safe for someone with Celiac disease. People who suspect they may have Celiac disease should consult a gastroenterologist.

Wheat allergy is generally outgrown in childhood. One study found that 56 percent of patients outgrew wheat allergy by age 8 and 65 percent outgrew it by age 12. Higher levels of wheat-specific IgE may indicate a lower chance of outgrowing wheat allergy, but wheat-specific IgE has not proven to be as reliable a marker as IgE for other allergens such as peanut, egg, or milk.

Wheat is also a common trigger in an unusual form of food allergy known as food-dependent, exercise-induced anaphylaxis. Symptoms of this condition are similar to symptoms of anaphylaxis but occur when exercising only after having eaten a trigger food like wheat. People with this condition are advised to exercise 2-4 hours or longer after eating their trigger food. This condition is likely due to altered absorption of an allergenic food during exercise. This is a rare form of anaphylaxis, but it is more common in women in their teens to mid-30s. A strong clinical history and possibly a food/exercise challenge can help diagnose this.

To confirm wheat allergy, an Oral Food Challenge (OFC) can be performed in a clinical setting with a board-certified allergist. Consult with a board-certified allergist for further information on performing a wheat OFC – risks may be involved, and not all patients are proper candidates.

Practical Tips

  • Avoid products containing wheat.

  • Always carry at least two (2) epinephrine auto-injectors at all times if you have been diagnosed with a wheat allergy. This is in case one misfires or if symptoms return and a second dose is needed.

  • Seek emergency medical assistance immediately after using an epinephrine auto-injector. This is due to the possibility of a biphasic reaction. A biphasic reaction is when a second reaction occurs due to the initial allergen exposure. Stay in medical care for at least 4-6 hours. Read all product labels prior to eating a new food product. Advisory statements found on food products such as “may contain” or “manufactured in facility that processes” are voluntary. Manufacturers are not required to include these advisory statements. Whether or not the statement appears on a product has no bearing on the product’s safety for people with food allergies. The absence of the statement also does not necessarily mean that product may have not been exposed to cross-contact. Cross-contact is when a food item has been manufactured on shared equipment with an allergen (for example, wheat) during the manufacturing process. Contact the manufacturer to confirm the safety of a product.

  • Cross-contact can also occur when utensils or equipment are shared, such as cooking and serving utensils. For example, a spatula used to cook pancakes, a spoon used to stir a baking mix, or common surfaces or trays used for kneading or baking dough. These utensils/surfaces are now contaminated with wheat and no longer safe for a wheat-allergic individual.

  • Cooking utensils should be thoroughly washed with soap and water after each use.

Visiting restaurants can be a pleasant experience for family and friends to gather together. However, some restaurants may pose a food-allergy risk. Restaurants, ice cream shops, candy shops, and bakeries are considered high risk for individuals with a wheat allergy due to the common use of wheat in foods here. There is also the risk of cross-contact even if a wheat-free item is ordered. Please visit our Restaurant Web page for tips on how to manage visiting a restaurant.

AVOID foods that contain wheat ingredients, such as:

  • Bread and bread crumbs (unless specifically labeled wheat-free)
  • Bulgur
  • Cereal extract (a flavor enhancer)
  • Couscous (a coarsely ground pasta made from semolina wheat)
  • Durum (durum flour or wheat)
  • Emmer wheat (also known as farro)
  • Einkorn wheat
  • Farina
  • Flour (all-purpose, cake, enriched, graham, high gluten, high protein, pastry, wheat)
  • Kamut
  • Pasta (unless made from non-wheat ingredients such as rice pasta)
  • Semolina
  • Spelt
  • Sprouted wheat
  • Triticale (a hybrid of wheat and rye)
  • Vital gluten
  • Wheat (bran, germ, gluten, malt, starch)
  • Whole wheat berries

Wheat in Unexpected Places*

  • Ale
  • Baking mixes and baked products
  • Batter-fried foods and breaded foods (Note: specifically ask what the batter/breading contains)
  • Beer
  • Candies
  • Cereals
  • Crackers
  • Gravy or roux (often thickened with flour)
  • Ice cream products
  • Hot dogs and processed meats
  • Pretzels
  • Salad dressings, sauces, and soups (usually thicker soups)
  • Soy sauce
  • Surimi (a paste made from fish or other meats) 

*It is important to check the safety of the products listed. However, some products listed may have safe alternatives. It is best to check with the manufacturer or restaurant to confirm the safety.

Foods generally considered safe for those with wheat allergy:

  • Amaranth
  • Arrowroot
  • Barley
  • Buckwheat
  • Corn
  • Millet
  • Oat (only pure oat not milled with other contaminating grains)
  • Potato
  • Quinoa (including quinoa flour)
  • Rice
  • Soybean
  • Tapioca

Significance of Wheat Removal from the Diet

Wheat is a common dietary staple in the United States, and families often have great difficulty with strict avoidance. The wide availability of gluten-free foods has helped with wheat avoidance to some degree. Many wheat-containing foods are fortified with vitamin A, vitamin D, niacin, and folic acid. To avoid nutritional deficits on a wheat avoidance diet, individuals may need to look at other food sources. A consultation with a nutritionist who has experience with food allergies may also be helpful to ensure balanced and adequate nutrition.

Other pages that may be of interest:

Visit FAACT's CROSS-CONTACT page to review how to properly clean allergens from hands and surfaces.