About Wheat and Gluten Allergies

Overview

A wheat allergy is an allergic reaction to wheat, which means that the body creates antibodies to proteins found in wheat. Gluten is a type of protein found in wheat, barley, rye, and triticale. While some people with a wheat allergy may have an immune response to gluten specifically, there are other proteins in wheat that can also cause an allergic reaction. Symptoms of a wheat allergy can include wheezing, hives, tightening in the throat, vomiting, diarrhea, coughing, and in severe cases, anaphylaxis. It is important for individuals with a wheat allergy to carry an epinephrine autoinjector (EpiPen) at all times due to the potentially life-threatening nature of anaphylaxis. Wheat allergies are more common in children, with approximately 3% being affected. However, two-thirds of children with a wheat allergy outgrow it by age 12. Diagnosis of a wheat allergy can be done through a skin test where wheat protein extracts are applied to pricked skin and checked for allergic reactions.

Gluten is the general name given to proteins found in wheat, barley, rye, and triticale. It is associated with several conditions including celiac disease, non-celiac gluten sensitivity (NCGS), and wheat allergy. Celiac disease is an autoimmune disease where the immune system attacks the small intestine when exposed to gluten. Non-celiac gluten sensitivity is a milder form of gluten intolerance that can cause unpleasant symptoms even when tests for celiac disease or a wheat allergy come back negative. It is estimated that NCGS affects anywhere from 0.5% to 13% of the population.

Both celiac disease and NCGS require adherence to a gluten-free diet as the only available treatment option. This means avoiding foods that contain gluten such as bread, flour, pasta, crackers, couscous, bulgur, farro, and farina. It's also important to read food labels carefully as gluten can be found in products like salad dressings, sauces, soups, and processed meats.

Causes and Risk Factors

Wheat and gluten allergies can be caused by a variety of factors. Here are the causes and risk factors associated with these allergies:

Causes of wheat and gluten allergies:

• Wheat allergy is triggered by an immunoglobulin E (IgE)-dependent mechanism. This means that the immune system reacts to wheat proteins, causing an allergic reaction.
• Gluten-related disorders, such as celiac disease, are caused by an immune response to gluten, which is a protein found in wheat, barley, and rye.

Non-modifiable risk factors of wheat and gluten allergies cannot be changed or controlled. These include:

• Family history: If a close relative has a wheat allergy, hay fever, or asthma, there is a higher risk that a person will develop a wheat allergy themselves.
• Age: Infants and young children are more likely to have a wheat allergy than older adults because their immune and digestive systems have not yet fully developed.

Modifiable risk factors of wheat and gluten allergies can be influenced or changed. These include:

• Timing of gluten introduction: Studies suggest that infants who begin to receive gluten either before four months or after seven months of age have a higher risk of developing celiac disease. The introduction of gluten during the optimal time between four and seven months may promote tolerance to celiac disease.
• Sensitization to other foods: In children with wheat allergy, other allergies like cow's milk, eggs, fish, soy, and nuts are often present. Sensitization to grasses is also associated with an increased risk of developing sensitization to wheat over time.

It's important to note that the current management for wheat and gluten allergies is dietary avoidance. This means avoiding foods that contain wheat or gluten to prevent allergic reactions or complications associated with gluten-related disorders.

Symptoms

Wheat and gluten allergies can cause a range of symptoms, both early on and as the allergy progresses or becomes more severe. Here are the most common early symptoms of wheat and gluten allergies:

• Allergic rhinitis: This is also known as nasal congestion. It can cause a stuffy or runny nose, sneezing, and itching.
• Asthma: Some people with wheat and gluten allergies may develop asthma symptoms, such as wheezing, coughing, and difficulty breathing.
• Atopic dermatitis: This is a type of eczema that can cause red, itchy rashes on the skin.
• Urticaria: Urticaria, also known as hives, is an itchy rash that appears as raised bumps on the skin. It can be accompanied by swelling.
• Gastrointestinal symptoms: Nausea, diarrhea, vomiting, stomach cramps, and bloating may occur in response to consuming wheat or gluten.

As the allergy progresses or becomes more severe, additional symptoms may occur. These can include:

• Anaphylaxis: Anaphylaxis is a severe and potentially life-threatening allergic reaction. Symptoms may include swelling and tightness in the throat, difficulty swallowing, chest pain, difficulty breathing, pale or bluish skin, weak pulse, and a drop in blood pressure. Anaphylaxis requires immediate medical attention.
• Digestive issues: In more severe cases of wheat and gluten allergies, digestive symptoms such as severe nausea, stomach cramps, and vomiting may occur.
• Congestion: Along with nasal congestion in the early stages of the allergy, later stages may involve more pronounced congestion symptoms like a stuffy or runny nose.
• Headaches: While headaches are rare in wheat and gluten allergies, they can occur in some cases.

It's important to note that each person's experience with wheat and gluten allergies can vary. Some individuals may only experience mild symptoms while others may have more severe reactions. If you suspect you have a wheat or gluten allergy or experience any of these symptoms after consuming wheat or gluten-containing foods, it's important to seek immediate medical attention for proper diagnosis and management of your condition.

Diagnosis

To diagnose wheat and gluten allergies, doctors typically perform a series of examinations, tests, and procedures. Here are the common ones:

• Patient history: The doctor will ask about the patient's symptoms and any previous allergic reactions to wheat or gluten-containing foods.
• Skin prick test: This test involves placing a small amount of wheat or gluten extract on the skin and then pricking it with a tiny needle. If the patient is allergic, they may develop a red, raised bump at the site of the prick.
• Specific IgE testing: This blood test measures the levels of specific antibodies called IgE that are produced in response to wheat or gluten allergens. Elevated levels of IgE can indicate an allergy.
• Oral food challenge: In this test, the patient is given increasing amounts of wheat or gluten under medical supervision to see if they develop any allergic symptoms. This is considered the gold standard for diagnosing food allergies.

In addition to these common tests, there are additional examinations and procedures that can help determine the severity of wheat and gluten allergies:

• Elimination diet: The patient eliminates all sources of wheat and gluten from their diet for a period of time, usually around 6 weeks. If their symptoms improve during this time, it suggests a possible allergy.
• Double-blind placebo-controlled challenge: This is a more controlled version of the oral food challenge where neither the patient nor the doctor knows whether they are receiving wheat or a placebo. It helps confirm the diagnosis in patients who have responded positively to a gluten-free diet.
• Basophil Activation Test (BAT): This is a diagnostic test that involves analyzing immune cells called basophils in the blood to see if they become activated in response to wheat or gluten allergens. BAT is still being studied and its use in clinical practice is not yet widespread.

It's important to note that these tests should be performed by healthcare professionals trained in allergy diagnosis, as they carry some risks, especially in cases where anaphylactic reactions may occur.

Treatment Options

The goals of treatment for wheat and gluten allergies are to manage symptoms, prevent allergic reactions, and improve quality of life. Here are some recommended treatments and how they work to achieve these goals:

• Avoidance of wheat and gluten:
• The primary treatment for wheat and gluten allergies is to avoid consuming wheat and gluten-containing products. This involves reading food labels carefully, choosing gluten-free alternatives, and being cautious about cross-contamination. By eliminating exposure to allergens, individuals can prevent allergic reactions and reduce symptoms.
• Medications:
  • Antihistamines: Antihistamines can be used to treat acute allergic reactions caused by wheat or gluten. These medications work by blocking the effects of histamine, a chemical released during an allergic reaction. By reducing histamine activity, antihistamines can relieve symptoms such as itching, sneezing, and hives.
  • Corticosteroids: In severe cases of wheat or gluten allergy, corticosteroids may be prescribed. These medications help reduce inflammation and suppress the immune system's response to allergens. Corticosteroids can be taken orally or applied topically to alleviate symptoms.
• Immunotherapy:
  • Immunotherapy is a promising treatment approach for IgE-mediated wheat allergy. It involves gradually exposing the immune system to increasing amounts of the allergen (wheat) to build tolerance over time. There are three types of immunotherapy being tested:
    • Sublingual immunotherapy (SLIT): In SLIT, small doses of allergen extract are placed under the tongue and absorbed into the bloodstream. This method helps desensitize the immune system to wheat allergens.
    • Oral immunotherapy (OIT): OIT involves ingesting small amounts of wheat protein under medical supervision. The dose is gradually increased over time to reduce allergic reactions.
    • Epicutaneous immunotherapy (EPIT): EPIT uses a skin patch containing the allergen (wheat) to deliver small amounts through the skin. This method aims to desensitize the immune system without inducing systemic reactions.
• Dietary management:
  • In addition to avoiding wheat and gluten, dietary management plays a crucial role in supporting individuals with wheat and gluten allergies:
    • Nutritional balance: It is important for individuals with these allergies to maintain a balanced diet that provides all necessary nutrients. Working with a registered dietitian can help ensure adequate nutrition while avoiding allergens.
    • Label reading: Checking food labels for hidden sources of wheat or gluten is essential in maintaining an allergy-friendly diet.
    • Cross-contamination awareness: Being aware of cross-contamination risks in food preparation is important to avoid accidental exposure to wheat or gluten.
• Impact of treatment:
  • For wheat allergies, avoiding wheat and related products is the primary treatment. If someone suspects they have a wheat allergy, it's crucial to seek immediate medical attention for diagnosis confirmation.
  • In celiac disease (CD), adherence to a gluten-free diet is currently the only proven treatment. This means avoiding all sources of gluten from wheat, rye, barley, and their derivatives.
  • Non-celiac gluten sensitivity (NCGS) management also involves following a gluten-free diet to alleviate symptoms.

It's important to note that the specific treatment plan may vary depending on individual circumstances and severity of allergies. Consulting with a healthcare professional or allergist can provide personalized guidance for managing wheat and gluten allergies effectively.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.

Progression or Complications

Wheat and gluten allergies can have different natural progressions over time. Here are some key points to consider:

• Natural progression:
  • Wheat allergies often develop in infancy, along with other food allergies. They commonly resolve by the age of 12, but some adults can still have a wheat allergy.
  • Celiac disease (CD), which is an autoimmune disorder triggered by gluten ingestion, can affect both children and adults. It affects about 1% of adults and children in the United States.
  • Non-celiac gluten sensitivity (NCGS) is another condition where individuals experience gastrointestinal and extraintestinal symptoms upon wheat ingestion, but without CD or wheat allergy.
• Complications:
  • For wheat allergies, common symptoms include allergic rhinitis (nasal congestion), asthma, eczema (atopic dermatitis), hives (urticaria), gastrointestinal issues like nausea, diarrhea, and vomiting, as well as mouth and throat irritation or swelling.
  • Anaphylaxis is a severe allergic reaction that can occur in response to wheat exposure. It can lead to swelling and tightness in the throat, difficulty swallowing and breathing, chest pain, pale or bluish skin, weak pulse, and a potentially life-threatening drop in blood pressure. Anaphylaxis requires immediate medical attention.
  • In celiac disease (CD), the ingestion of gluten can cause chronic immune-mediated small intestinal enteropathy. This leads to gastrointestinal symptoms such as abdominal pain, diarrhea, and bloating. CD can also have extraintestinal manifestations like fatigue, joint pain, skin rashes, and nutrient deficiencies.
  • Non-celiac gluten sensitivity (NCGS) can cause similar gastrointestinal symptoms as CD but does not involve the same autoimmune response.

It's important to note that while there are treatments available for managing these conditions, it's always best to consult with a medical professional for personalized advice and guidance. They can provide accurate diagnoses and recommend appropriate treatment options based on individual needs.