Wheat Allergy

Food allergy occurs when the body’s immune system reacts to a harmless food component, usually a protein, because it mistakenly registers that substance as a threat. In people with immediate onset food allergy, the immune system has produced substances called immunoglobulin E antibodies (IgE). When these IgE antibodies identify the presence of the allergenic food in the body (in this case wheat), they trigger the allergic reaction. Most people react when they eat wheat or wheat products, but a reaction can be triggered by touching or breathing in wheat, although this is rare.

Gluten is one of the many proteins in wheat. If you are allergic to wheat, you may be reacting to gluten and/or other proteins.

Symptoms of wheat allergy

Symptoms may occur within seconds to minutes after the food is eaten, but can happen up to two hours after exposure. You may show some or all of the following:

Mild-to-moderate symptoms of wheat allergy

Fortunately most reactions show only mild-to-moderate symptoms, which can be treated with antihistamines. These symptoms include:

• Itching

• Nettle rash (also known as hives or urticaria)

• Tingling or itchy mouth, runny nose

• Swelling of the lips or face (angioedema)

• Abdominal pain.

Severe symptoms (known as anaphylaxis)

Emergency medical help must always be sought for potentially life-threatening symptoms. Adrenaline must be given and an ambulance called. Severe symptoms include:

• Swelling of the tongue or throat

• Difficulty breathing and/or swallowing, cough, shortness of breath

• Voice becomes hoarse, husky

• Severe symptoms of the digestive tract – such as severe abdominal pain and profuse vomiting

It’s important to remember that digestive symptoms can also occur with other wheat-induced conditions. When severe digestive symptoms occur rapidly as part of anaphylaxis, other allergic symptoms such as nettle rash (hives or urticaria) and angioedema (swelling) will usually also be present.

Remember the importance of getting expert medical advice.

Anaphylactic shock

On rare occasions the symptoms of anaphylaxis may progress to full anaphylactic shock, where blood pressure drops sharply and the person becomes pale, limp, floppy, may lose consciousness and stop breathing. This can happen very quickly.

A positive diagnosis should mean that the allergy clinic develops a written allergy action plan for you. Injectable adrenaline may be prescribed for self-administration, as well as antihistamines.

The adrenaline injectors currently prescribed in the UK are EpiPen, Jext and Emerade. These injectors are designed for self-administration.

If you are prescribed an injector, it should be carried with you at all times – with no exceptions. Adrenaline must be administered as soon as a severe reaction is suspected and an ambulance called.

Symptoms may worsen and more than one injection of adrenaline may be required to control the reaction. Oxygen and steroids may be needed, and you are likely to need hospital monitoring in case of a second reaction (known as a biphasic reaction).

If you are prescribed an adrenaline injector, you will need to know how and when to use it. Ask your GP or allergist for advice on this. You can also find help on the website relevant to the injector you carry.

Emerade 

EpiPen

Jext

Make sure that your family, friends, colleagues, and school or nursery if appropriate, know about your allergy and how to spot and treat the signs of anaphylaxis.

For some people, an allergic reaction to wheat can only occur in conjunction with exercise. If they eat wheat without exercise, symptoms do not occur. The correct medical term for this is ‘wheat dependent exercise-induced anaphylaxis’ (WDEIA).

Any exercise-induced allergy is complex and needs the expert diagnosis of a specialist at an allergy clinic. The specialist will be able to consider which cases require an adrenaline injector to be prescribed.

If you need to avoid wheat it is vital to read food labels carefully every time you shop as food producers sometimes change the ingredients they use. It is helpful that all pre-packaged food must declare and highlight the presence in the ingredient list of major allergens including cereals containing gluten, of which wheat is one.

There are also strict regulations governing food sold in catering establishments. When eating out or buying takeaway food, food businesses must provide information on major allergenic ingredients including cereals containing gluten. This information can be provided orally and/ or in writing. If information is provided orally, the food business will need to ensure that there is some sort of written signage that is clearly visible, to indicate that allergen information is available from a member of staff. Systems should also be in place to ensure that, if requested, the information given orally is supported in a recorded form to ensure consistency and accuracy.

You should question staff very directly, asking whether wheat is an ingredient of the food you have chosen or whether there is a risk of cross-contamination. Don’t be afraid to ask the waiter to check with the chef. Make it clear that you have a life-threatening allergy, if this is the case.

Schools and nurseries should be able to cater for allergen-free diets and you will need to agree a school or nursery written Allergy Action Plan with them.

Ingredients which might contain wheat include:

Processed foods including gravy, salad dressings, sauces, soups, Yorkshire pudding and burgers. There are many other examples.

All types of bread including rolls, malt bread, chapatti, pitta, naan, paratha, croissants, soda bread and fancy breads. Wheat-free bread is available in many supermarkets. Food labelled ‘gluten free’ may not necessarily be suitable for people with wheat allergy (see our section below headed Gluten-free foods).

• Wheat-based breakfast cereals. Look out for anything with wheat in the name, as well as bran and read ingredient lists carefully.
• Pasta and other wheat products. Avoid any pasta made with wheat or semolina. Pasta is found in some soups such as minestrone. Other wheat-based foods to avoid include couscous, rusks, pizza, spelt and semolina.
• Desserts and sweet things. Anything containing wheat or wheat flour is a problem food including cakes, crackers, pastries, ice cream wafers and cones, biscuits, doughnuts and batter.
• Hydrolysed vegetable protein (HVP) can be derived from wheat and is used to give a savoury flavour to products such as sauces, soups and gravies.
• Modified starch. Avoid modified wheat starch and raising agents such as baking powder unless it is wheat-free.
• Beers can also contain wheat as well as barley, and they will certainly contain gluten.

The above list covers many wheat-containing foods, but there may be others.

‘Gluten-free’ foods

Under EU law, products labelled ‘gluten-free’ must contain no more than 20 parts per million of gluten. The UK is still covered by this legislation even though we left the EU in January 2020.

Be aware that the description ‘gluten-free’ is based on the principle that this level of 20 parts per million will be safe for people with coeliac disease. Some people with wheat allergy react to amounts less than 20 parts per million if a reasonable portion is eaten. There is not enough research to determine what level of wheat is safe for people with wheat allergy, so we advise all those affected to avoid ‘gluten-free’ foods (unless you can be sure that wheat is not an ingredient). Remember too that gluten may not be the only protein in wheat to which you may react.