Wheat allergy

Alongside the traditional wheat allergy, there are two other particular types of wheat allergy: wheat dependent, exercise-induced allergy or anaphylaxis in adults and occupational baker’s lung, also known as baker’s asthma. Children who have an allergic reaction to wheat often come to tolerate it over time.

Triggers

The different proteins in wheat responsible for food allergy are albumins, globulins and gluten. Gluten is found in the endosperm, the globulins and albumins particularly in the hull.

Special case – wheat-dependent, exertion-induced anaphylaxis(WDEIA)

The proteins in the wheat (gluten) are also the triggers in this form of wheat allergy. Sufferers can normally tolerate wheat in periods when they are not physically active. An allergic reaction is only triggered when, for example, they eat wheat and perform physical exercise (e.g. sports) or take non-steroidal anti-inflammatory drugs.

Special case – baker’s lung or baker’s asthma

Bakers also often have a wheat allergy. However, this is not a food allergy. It is a respiratory allergy triggered by breathing in wheat flour and is more commonly known as baker’s lung or baker’s asthma. Sufferers can tolerate wheat when they eat it.

Presence

Wheat and related grains such as spelt, emmer, unripe spelt and kamut must be avoided with a wheat allergy. They are common ingredients in many bakery products and ready meals but can also be found in meat products and many other foods as well. Semolina, bulgur and couscous are also wheat products. Purchasing Guide in German «Einkaufshilfe Weizenallergie»

Cross-reactions

The likelihood of a cross-reaction with other grains is high, especially with rye and barley.

Course of the allergy

It is possible to outgrow a wheat allergy. Infants can tolerate wheat as they get older. An annual check with the treating professional is thus recommended.

Symptoms

With a wheat allergy, symptoms appear within minutes and to an hour after consumption and typically include itching in the mucous membranes of the mouth and on the skin with redness, wheals and swelling. Like other food allergies, respiratory symptoms may also occur. Isolated gastrointestinal symptoms are rare. They usually occur in combination with other allergy symptoms, such as difficulty swallowing, nausea, vomiting, diarrhoea and bloating. In rare cases, the allergy may result in anaphylactic shock with breathing difficulties and circulatory collapse.

Special case: WDEIA

As the name indicates, symptoms of an allergy or anaphylaxis occur after eating wheat followed by physical exertion. Milder symptoms affect only the skin and mucous membranes and include wheals and hives. With severe allergic reactions, other organ systems such as the digestive tract, the respiratory tract and cardiovascular system are also affected.

Special case: baker’s lung/baker’s asthma

The symptoms of baker’s lung/baker’s asthma are very similar to those for a pollen allergy, with sneezing fits, runny nose (rhinitis), blocked nose, difficulty breathing through the nose, itchy and watery eyes (conjunctivitis) as well as asthma attacks. If untreated, the sufferer may develop asthma.

Diagnosis

Self-monitoring – ideally recorded in a symptom diary – and a consultation with an allergy specialist, together with the results of skin and blood tests, are the essential basis for the diagnosis of egg allergy. To confirm the diagnosis and to determine the tolerance level, provocation (or challenge) tests may also be required.

Special case: WDEA

With wheat-dependent, exertion-induced anaphylaxis, a food and symptom diary and the results of skin and blood tests are also the basis for diagnosis. To confirm the diagnosis, a provocation (challenge) test may also be required.

Special case: baker’s lung/baker’s asthma

This also involves taking a thorough medical history and skin and blood tests.

Treatment

Strict avoidance of the food causing the allergy is essential. It is also essential to watch for concealed sources in bakery products, sausage, spice blends and semi-cooked and ready meals. If there is a risk of an anaphylactic reaction, it is essential to strictly avoid even the tiniest amounts (traces / contaminants). Whether traces can be tolerated should be decided by an allergy specialist. They may use a provocation or challenge test to determine the level of tolerance to the allergen.

A specialist dietician can provide helpful support in implementing treatment in daily life. For example, to discuss the use of alternatives to wheat, to learn how to read ingredient lists, to receive practical advice and to discuss possible changes to one’s personal daily life. The supply of essential nutrients (protein, vitamins and minerals) should be assessed by a specialist dietician and monitored by the treating paediatrician/doctor.

Anyone who has already suffered a severe allergic reaction should always carry an emergency medical ID card and an emergency kit to ensure prompt treatment of any further severe allergic reaction. In any event, once first aid has been administered, they should then seek medical attention from an emergency doctor or hospital.

Special case: WDEIA

Strict avoidance of the trigger of wheat and other grains that contain gluten also applies to WDEIA. However, many sufferers do not need to give up wheat, as they can usually tolerate it well, provided they do not perform physical exercise or take pain-killers after eating it. As a rule, no grains containing gluten should be eaten four to six hours before physical exercise. Sufferers are also given an emergency kit, with an adrenaline auto-injector, that they carry with them at all times to ensure prompt treatment of any further severe allergic reaction.

Special case: baker’s asthma

With baker’s asthma, contact with wheat flour should be kept to a minimum, for example, by reducing the amount of flour dust being generated.

Labelling of food

The presence of wheat in food must be declared in Switzerland and the EU. This means that the ingredient and any products produced from it are clearly labelled and highlighted on the packaging – for example, in bold type, italics or in capital letters. Unintentional mixtures/combinations must also be mentioned at the end of the list as follows: “may contain …” or “may contain traces of …”. Sales staff in shops selling food (e.g. bakeries, butcher’s etc) and in restaurants, takeaway kiosks etc must also provide information. By law, information supplied verbally by a professional is adequate.

Tips and tricks

• Write the allergy-causing foods on a “visiting card” and hand to restaurant staff when ordering.
• Before holidays, have these cards translated into the local language and take them with you.
• When invited round to friends and family, either tell the hosts exactly about your allergy or offer to take something allergen-free with you.
• Check lists of ingredients of familiar foods before buying. The recipes can be changed at any time. If you are not sure, the manufacturers or wholesalers will be glad to provide information. Their contact details can be found on the packaging.
• When shopping, look out for products with the Allergy Seal of Quality, these are particularly suitable for people with allergies and intolerances and are recommended by aha! Swiss Allergy Centre.

Facts and figures

• 6% of children with a food allergy have a wheat allergy.
• Wheat is also responsible for anaphylactic reactions in children.
• Wheat is one of the primary triggers for anaphylactic reactions in adults due to wheat-dependent, exertion-induced anaphylaxis.

Wheat allergy: FAQs

Is it safe for me to consume gluten-free products if I have a wheat allergy?

Not in every case. It is important to read the list of ingredients carefully. Not all gluten-free products are suitable for wheat allergy sufferers, as being free of gluten does not mean that they are free of other wheat allergens (e.g. in the form of gluten-free wheat starch).

What is the difference between wheat allergy and coeliac disease?

identifies them as foreign and thus triggers a cascade of reactions (see symptoms above). Coeliac disease, on the other hand, is not an allergic reaction. In coeliac disease sufferers, the binder protein gluten damages the inner lining of the small intestine. This damage causes the atrophy of the villi, reducing the surface area of the intestine. Nutrients such as carbohydrates, fats, proteins, vitamins and minerals are less well absorbed as a result and are not available to the body in sufficient quantities. In the course of the disease, these nutrient deficits can lead to deficiency symptoms such as iron deficiency and consequent effects such as anaemia.

And what is wheat sensitivity?

It is still unclear whether wheat sensitivity or isolated gluten sensitivity occurs unless an allergy or coeliac disease is also present and what the cause might be. It is known that patients with irritable bowel syndrome sometimes tolerate wheat poorly, as it contains a protein known as fructan that is fermented by bacteria in the gut and can lead to bloating. Other grains such as spelt are better tolerated. However, these should be avoided with wheat allergy and coeliac disease. Unlike wheat allergy and coeliac disease, there are no reports with wheat sensitivity of damage to the intestinal wall or the presence of specific antibodies.

Editors: aha! Swiss Allergy Centre in co-operation with the Scientific Advisory Board.