Wheat allergy is among the eight most common food allergies, affecting as many as six percent of children under the age of three and are much less common among adults.
It is caused by an IgE reaction to one or more of the proteins found in the wheat grain. There are many allergenic components in wheat, for example serine proteinase inhibitors, glutelins and prolamins and different responses are often attributed to different proteins.
Types of allergensThere are four major classes of seed storage proteins: albumins, globulins, prolamins and glutelins. The majority of IgE-mediated reactions to wheat involve the albumin and globulin fractions. Gliadin and gluten may also induce IgE-mediated reactions rarely.
Gluten allergyGluten gives elasticity to baked goods and the chewy texture of many breads and products. It is associated with celiac disease which causes symptoms of diarrhea, windy bloating, nausea, tiredness, pale offensive feces; absorption difficulties which may lead to poor growth in babies and weight loss in adults.
Some people with celiac disease develop dermatitis herpetiformis which has symptoms of severe skin rash /tiny blisters and damage to the intestinal lining and sometimes diarrhea.
Prolamin and glutelin allergiesGlutinins are a more frequent allergen and gliadins are associated with the most severe disease. Nine subunits of low molecular weight-glutinen have been found to bind to wheat allergy associated.
Albumin and globulin allergyResearch suggests that there is an increased presence of allergies to amylase/trypsin inhibitors (serpins) and lipid transfer protein (LPT) but less reactivity to the globulin fraction. The allergies tend to differ between populations, indicating a potential genetic component to these reactivities.
Wheat allergy and gluten intoleranceDuring wheat allergy, the immune system gets hypersensitive to one of the proteins in wheat, so the system reacts against the protein as though it was some foreign invader. A reaction may occur from ingesting wheat or inhaling baking flour. Fortunately, true wheat allergy is quite rare. These people must observe a strict wheat-free diet to remain healthy.
However, most people who speak of wheat allergy are actually referring to wheat intolerance caused by gluten. It affects one in seven people or 15%.
Symptoms of wheat allergy - gluten intoleranceCommon symptoms of wheat allergy can begin anywhere between a few minutes to a few hours after eating. Symptoms often involve the skin reactions such as rashes, hives, and eczema. However the symptoms for gluten intolerance are much more varied and usually have a delayed onset up to 2 or 3 days later. The symptoms include:
- Gastro-intestinal (stomach bloating and cramping, diarrhea, flatulence, constipation etc.)
- Neurological: headache, memory loss, behavioral difficulties, depression
- Immune: poor resistance to infection, mouth ulcers, arthritis
- Skin rashes, eczema, psoriasis, itching flaky skin
- General: food cravings, tiredness, chronic fatigue, unwell feeling.
Foods to be avoidedConventional medical advice in dealing with food related allergy is to avoid the substance that you are sensitive to. Since wheat is a staple diet in the US, avoidance becomes a major nightmare. This type of avoidance diet severely limits the selection of foods and may even require the assistance or supervision of a dietician.
When avoiding wheat, you are actually avoiding one or more of the proteins in wheat, including gluten, gliadin, globulin, and albumin. Gluten, however, is quite difficult to avoid. You will need to be aware of the following foods since they contain wheat:
- alcoholic beverages, some baby foods, barley malt
- batter-fried foods, biscuits, bologna
- bouillon, bran, bread, bread crumbs
- bulgur, buns, cakes, candy
- cereals, chocolate, cocoa, cold cuts
- cookies, cornbread, crackers, cream of wheat
- croutons, doughnuts, dumplings, farina
- flours, graham crackers, granola, gravies
- hot dogs, ice cream, ice cream cones, liverwurst
- macaroni, malt products, malted milk, matzos
- mayonnaise, MSG, muffins, noodles
- ovaltine, pancake mixes, pasta
- pastries, pepper, pies, pita bread, pizza
- pretzels, puddings, pumpernickel bread, rolls
- rye bread, sauces, sausages, soups
- soy sauce, tamari, spaghetti, tortillas
- vermicelli, waffles, wheat germ, some yeasts
Wheat allergy - gluten intolerance treatmentThe main conventional treatment for food allergies is allergen avoidance. Thus you need to identify the foods causing your reactions, and then avoid them.
Alternative cerealsTriticeae gluten-free oats (free of Wheat, rye or barley) may be a useful source of cereal fiber. Some wheat allergies allow the use of rye bread as a substitute. Wheat-free millet flour, buckwheat, flax seed meal, corn meal, quinoa flour, and chia seed flour can also be used as substitutes. Spelt and kamut are grains closely related to common wheat, and are not usually a suitable substitute for people with wheat allergy or celiac disease. Rice flour is a commonly used alternative for those allergic to wheat.
Many people with wheat allergies are also allergic to soy, milk and alternate food ingredients. Many alternative cereals/flours substitute soy and/or dairy products. Those with wheat/gluten sensitivity should read labels carefully.
Medical treatmentMedical treatment for wheat related allergy as well as food allergy in general can include the following:
- Epinephrine - given for severe allergic reactions.
- Diphenhydramine (Benadryl) – is a common antihistamine
- Corticosteroid – in cream or ointment form to reduces swelling and various symptoms of allergic reactions.
Management of wheat allergy in childrenWheat allergy requires all wheat products to be removed from a child’s diet. Wheat elimination diets are particularly difficult to maintain. It is important that parents know how to read labels to recognize ingredients that indicate the presence of wheat proteins like gluten, wheat starch, bran, vegetable starch or vegetable gum. Children on wheat-restricted diets are severely limited in their choice of foods and should be evaluated for possible nutritional deficiencies of vitamin B and iron. But such a child can still have a nutritionally complete diet as well as can continue to enjoy some selective kid favorites.
The primary nutrients found in wheat are carbohydrate, protein, niacin, zinc, magnesium, fiber as well as fortification with folic acid and iron. A child can get all these nutrients from various other foods, but there is a risk for not getting enough B vitamins. Other sources of B vitamins include dark leafy vegetables, bananas, asparagus, oranges, peanuts, and other fortified grains such as corn meal and rice flours. A wheat allergic child’s diet must be supervised by a dietician who provides wheat-free recipes and ensures nutritionally adequate diet.
Also, it is wise to educate a child to the dangers of sharing foods and prepare the child's lunch at home. Parents must talk with teachers and the school administrator regarding the child's needs. Teachers can be requested to keep an eye out and explain the situation to other children if appropriate. It is advised to make and maintain a card that lists foods and ingredients that should be avoided. This card can also helpful to older children in making decisions when out with friends.