Wheat Allergy

Wheat allergy is one of the most common IgE-mediated food allergies children can experience. If your child has a wheat allergy, they will have an abnormal reaction when exposed to wheat – either by eating foods that contain wheat, or in some cases, by inhaling tiny amounts of wheat flour.

Children who have a wheat allergy will typically show symptoms within minutes or hours of eating or being exposed to wheat. Symptoms may include difficulty breathing, nausea, hives and, in severe cases anaphylaxis, a life-threatening allergic response. Allergic reactions to wheat can appear similar to celiac disease and gluten sensitivity, so it's important to ensure your child receives the correct diagnosis and treatment.

Wheat allergies are typically caused when the body misidentifies one of the four proteins in wheat as something harmful. Normally, our bodies release histamine in response to something that may make us sick – such as a parasite. But sometimes, this process is triggered by items that are traditionally safe, such as foods.

When an allergic child eats, or is otherwise exposed, to a triggering food, those proteins enter their bloodstream. The histamine reaction that follows is why symptoms can appear in multiple parts of the body. 

When your child has a food allergy, their body's IgE antibodies identify that specific food – wheat, in this case -- as an invader and can produce symptoms in multiple areas of the body, including:

• Skin: hives (red, blotchy skin that may be itchy) that may include mild to severe swelling
• Lungs: difficulty breathing, shortness of breath, coughing or wheezing
• Eyes: itching, tearing or redness
• Throat: tightness, trouble breathing or inhaling
• Stomach: repeated vomiting, nausea, abdominal pain, cramping, which may lead to diarrhea
• Nose: congestion, clear discharge or itch
• Headache

If your child experiences any of these symptoms after eating wheat, call your pediatrician and arrange to have your child tested by a pediatric allergist.

In some cases, exposure to wheat may cause anaphylaxis, a life-threatening allergic response. Symptoms of anaphylaxis include:

• Severe difficulty breathing
• Swelling in the throat and/or difficulty swallowing
• Chest pain or a feeling of tightness
• Dizziness or fainting
• Skin color becoming paler or blue

If your child has symptoms of anaphylaxis, call 911 immediately.

Wheat allergy symptoms can mimic those of other conditions such as gluten sensitivity or celiac disease. Clinicians at Children's Hospital of Philadelphia will take a detailed medical history of your child, including information on prior food reactions, to ensure your child is accurately diagnosed and receives the correct treatment plan.

Your child with a suspected wheat allergy may be seen by clinicians in the Food Allergy Center or the Center for Celiac Disease. Testing will determine which team is best suited to treat your child's condition.  Watch this video to learn more celiac disease and other gluten disorders in children.

In addition to learning your child's medical history, clinicians may order tests to get more information about your child's medical condition and reactions. These assessments may include:

Skin test

In allergy skin testing, a very small amount of wheat in introduces to your child's skin, usually on the forearm, then the skin is "pricked" with a needle to introduce the allergen into the skin. The testing site is observed for 10-15 minutes to observe the type and kind of reaction, if any.

Blood test

In allergen-specific IgE blood tests, a small amount of your child's blood is drawn and tested for antibodies the child may have produced in response to exposure to an allergen. A blood test may also be used to check for possible celiac disease, which has some similar symptoms for food allergies.

Food challenge

A food challenge test involves giving the child a small amount of the potentially allergic food in a clinical setting to monitor for any reactions.  

Once clinicians confirm your child has a wheat allergy, the first step in treatment is avoiding wheat and any food products that contain it. Some wheat-containing foods are obvious, such as many breads and cereals. But wheat is also used in many foods that aren't as obvious, including soy sauce, some processed meats, soups, sauces and even ice cream. Some items, such as buckwheat, may seem like they should be avoided (wheat is in the name, after all) but are safe for children with wheat allergies to eat.

Your child's doctor can give you detailed information on how to read food labels to help identify and avoid potential allergic triggers.

When you learn your child has a wheat allergy you may worry it will severely limit your child's food options. Your child's doctor can give you detailed information on how to read food labels to help identify and avoid potential allergic triggers. And CHOP nutritionists can help you find substitute ingredients that allow your child to still enjoy most of their favorite foods and maintain a healthy, balanced diet.

No matter how careful you are, there may be times when your child is accidentally exposed to wheat and has a reaction. When that happens, antihistamines or epinephrine may be used to treat the symptoms.

Allergic reactions to wheat can occur quickly. Whenever more than one body system is involved in a food reaction (i.e. throat and skin), the best treatment available is Epinephrine. Epinephrine comes in a variety of forms, including auto-injectors such as Epi-Pen, Auvi-Q and other generic forms.

If your child's reaction is mild at first — antihistamines can ease the symptoms of the food allergy. Antihistamines are available in over-the-counter or prescription strengths. Your child's doctor can help you decide which option may work best for your child.

If you've given your child an antihistamine and the allergic reaction quickly worsens, you should give them epinephrine. Children with food allergies should carry epinephrine with them, or it should be readily available at places where they routinely spend time such as school, daycare and home.

When to call 911

If your child has a severe reaction or signs of anaphylaxis, call 911 right away. Even if they've already received epinephrine, it wears off quickly, and your child may need additional medication or treatment to address their symptoms. 

Most of the ongoing treatment for allergies can be done at home. Once your child has been diagnosed with wheat allergy, you and your family will be given more information on how to avoid exposure to wheat and treat any reactions you child may experience.

You may also want to share information on the allergy with extended family, close friends and your child's school so they can help you reduce the likelihood of accidental exposures outside your home.

Some children with food allergies, including to wheat, will eventually outgrow the allergy as they approach puberty. It's important that your child undergo a supervised test – such as a food challenge – to determine if they must continue avoiding the food or can incorporate it into their diet.

It's easier than ever to accommodate children with wheat allergies. Food labeling rules have improved to make it easier to catch potentially triggering foods and commercially prepared food in stores and restaurants are more likely to have wheat-free options. 

CHOP is one of several medical centers actively researching the causes and potential new treatments to food allergies such as wheat. If you are interested in learning if your child could benefit from an oral or skin desensitization study, contact CHOP's Food Allergy Center at 215-590-2549 or the Center for Celiac Disease at 215-590-3076.