All you need to know about wheat allergy and wheat intolerance

If you have wheat allergy, exposure to a wheat protein primes your immune system for an allergic reaction.

Some people with wheat allergy develop symptoms only if they exercise within a few hours of 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, called wheat-dependent exercise-induced anaphylaxis (WDEIA), usually results in life-threatening anaphylaxis.

Another variant is related to baker’s asthma, a serious occupational obstructive airway disease that affects between 4% and 25% of bakery workers worldwide. Wheat flour is the primary cereal used in bakery products and wheat flour allergy is the leading cause of baker’s asthma.

Certain factors can lead to a greater risk of developing wheat allergy:

• Family history. A person is at increased risk of allergy to wheat or other foods if their 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. But adults can also develop a wheat allergy.

Wheat allergy symptoms most commonly affect the skin and respiratory system, often occurring shortly after eating foods that contain wheat. Some people may also experience digestive symptoms, which can develop immediately or several hours later.

There are a wide range of wheat allergy signs and symptoms, including:

• 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

For some people, a wheat allergy can trigger a severe, potentially life-threatening allergic reaction called anaphylaxis. Symptoms may include chest tightness, throat swelling or tightening, difficulty breathing or swallowing, pale or bluish skin, dizziness, or loss of consciousness. Immediate medical attention is required if anaphylaxis is suspected.

If someone shows signs of anaphylaxis, call 911 immediately and seek emergency medical care. Anaphylaxis is a medical emergency that requires immediate medical attention and can result in death.

If you suspect that you or your child is allergic to wheat, make an appointment to see your doctor for evaluation.

As with other food allergies, it's helpful to keep a food and symptom diary to track reactions and identify potential triggers. Diagnosis typically includes allergy testing, such as blood tests that measure specific antibodies and/or a skin prick test. If symptoms such as abdominal pain, diarrhea, or nausea occur after eating wheat, it is important to rule out celiac disease before further evaluating for a wheat allergy, as the symptoms can be similar.

Diagnosis of wheat allergy can be made through a skin-prick test or a blood test.

In the skin-prick test, a small amount of a liquid containing wheat protein is placed on the back or forearm, which is then pricked with a small, sterile probe to allow the liquid to enter the skin. If a raised, reddish spot forms within 15 to 20 minutes, this can indicate an allergy.

In the blood test, a blood sample is sent to a laboratory to test for the presence of immunoglobulin E antibodies to wheat protein.

Wheat allergy is most common in small children, who often outgrow wheat allergy, but adults can also develop a wheat allergy. Up to 1% of children in the US have a wheat allergy with two-thirds of children likely to have outgrown their wheat allergy by the time they are 12 years old (https://pubmed.ncbi.nlm.nih.gov/19492663/).

The main treatment for wheat allergy involves a change in diet. Once the allergist has diagnosed wheat allergy, you must eliminate wheat from your diet.

Keep in mind that wheat can be found in many processed foods where you might not expect it. That's why it's important to read ingredient labels carefully and check for wheat-containing ingredients, even in products that don't appear to contain wheat. For instance, rye bread can also contain wheat. Gluten-free products are not the same as wheat-free products, because they may contain gluten-free wheat starch,

which should not be consumed by people with wheat allergy. It is important to always the food label and ingredients list before purchasing a product.

In addition to breads, baked goods, breakfast cereals, pasta, couscous, spelt, and semolina, wheat ingredients can also be found in products such as crackers, soy sauce, processed meats (including some hot dogs and deli meats), flavorings, modified food starch, pregelatinized starch, and certain dairy products. Always read ingredient labels carefully, as wheat can appear in unexpected foods.

To help ensure a balanced diet while avoiding wheat, consider working with a registered dietitian. A dietitian can help you identify safe alternatives, meet your nutritional needs, and provide practical tips for cooking, baking, and dining with a wheat allergy.

How long do wheat allergy symptoms last? 

There is no way to predict how long a wheat allergy will last. Many children who develop wheat allergy outgrow it over time, but some continue to have the allergy into adulthood. In general, wheat allergies that develop later in life are more likely to be long-lasting or permanent.