Wheat Allergy

Wheat allergy may affect up to 1% of children in the US (1). Up to two thirds of children with a wheat allergy may outgrow it by the time they are 12 years old, however others will remain allergic to wheat throughout their entire lives.

When a person with wheat allergy is exposed to the proteins in wheat, the proteins bind to IgE antibodies that trigger the immune system, causing a reaction. This is different from celiac disease which is an autoimmune disease that often affects the gastrointestinal tract.

How to Introduce Wheat

As with other allergens, introduce wheat as the only new food that day. If you are looking for a more comprehensive guide to introducing allergens, then check out my Allergy Introduction Handbook. Note that some of these foods do contain other allergens (noted with an *).

• Strips of toast (avoid breads with honey or nuts/seeds as they can be a choking hazard)
• Pasta cooked soft
• Wheat tortillas in a quesadilla*
• Alternative grains such as farro or bulgar

Diagnosis

The gold standard for the diagnosis of a food allergy is an oral challenge. While scary, it’s actually an easy test to perform: if the child eats the allergen, do they consistently produce a reaction? If so, they are allergic. Then, to confirm a diagnosis, a doctor may use a blood test or skin prick test. A medical professional should always make the diagnosis as a self-diagnosis can lead to unnecessary restriction.

Celiac Disease versus Wheat Allergy

With celiac disease, antibodies are produced in the presence of gluten, a protein found in wheat, barley and rye (2). These antibodies can result in inflammation and cause damage to the lining of the intestine. This damage can lead to an inability to absorb nutrients. Most often symptoms involve the gastrointestinal tract, such as diarrhea, constipation, abdominal pain, bloating, and weight loss. Sometimes symptoms can include skin rashes or issues from nutrient deficiencies. It’s estimated that about 1% of the population has celiac disease (3).

Like with food allergies, there is a genetic component to celiac disease. It is currently still recommended to expose children to gluten, even if parents have known celiac disease. You can request testing if your child has a risk factor like family history of type 1 diabetes.

How to Avoid Wheat

It may not be as simple as just not eating wheat. Wheat can come into contact with other foods during processing. There can be cross-contact in the kitchen if the cook touches wheat or wheat products and then cooks another dish.

Wheat is the most common grain product in the United States (4). It’s not common for someone with a wheat allergy to be allergic to other grains with the exception of barley. Some alternative grain options include amaranth, oats, corn, rice, quinoa, and rye.

It’s very important to always check food labels. Companies need to list wheat clearly on the ingredients list in plain language or under the label in a statement that reads “Contains wheat.”

Places to Check

Always ask about ingredients in foods that you did not make yourself. When eating at a restaurant, there is always a risk of cross-contact, so it is important to make it very clear that there is an allergy.

Wheat on Labels

Any of these terms may indicate that a wheat product is present:

• Bread crumbs
• Bulgur
• Club wheat
• Couscous
• Durum
• Einkorn
• Emmer
• Farina
• Farro
• Flour (unless listed as an alternative grain specifically)
• Freekeh
• Hydrolyzed wheat protein
• Kamut
• Matzo
• Pasta (unless made from an alternative grain or bean)
• Seitan
• Semolina
• Spelt
• Sprouted wheat
• Triticale
• Vital wheat glutan
• Wheat in any form (bran, durum, germ, germ oil, wheat grass, wheat protein isolate, wheat sprouts, wheat starch)
• Whole wheat berries

Buckwheat is not related to wheat and is ok to eat with a wheat allergy.

Other Places to Check

While not always present, wheat can be found in glucose syrup, soy sauce, starch, surimi, and plant based meat alternatives. Always check the food labels to make sure that wheat was not used if you have an allergy.

Wheat is also found in ale, baked goods or mixes, batter fried foods, beers, breaded foods, cereals, some candies, crackers, hot dogs, some ice creams, marinara sauces, play dough, potato chips, processed meats, rice cakes, salad dressings, sauces, spices, and soups.

Wheat Alternatives

There are many alternative grains that you can use if you have a wheat allergy. Many pastas are now being made with alternative grains giving more options. For sides, there are many choices such as rice or quinoa.

When baking, it’s usually best to use a combination of wheat free flours to create the best texture. I usually recommend trying to find recipes that already use alternative flours as it can take a little bit of practice to figure out the best combination.

Wheat Allergy Symptoms

Although reactions can range from mild to severe, it is usually recommended for all kids with wheat allergies to have an epi-pen with them at all times. Epinephrine is used to treat anaphylaxis, a severe reaction to allergies.

This is not intended as medical advice. If you have any concerns about your child, reach out to your physician. If your child is having multiple symptoms or severe symptoms, call 911.

	Mild	Severe
Skin	mild rash, some hives	widespread rash, hives all over the body
Face	itchy mouth, runny nose, sneezing	lip swelling, tongue swelling
Gastrointestinal	nausea	vomiting, diarrhea
Airway	none	coughing, wheezing, trouble breathing