Wheat
Allergy Facts, Symptoms, and Treatment

Wheat is a cereal grass whose processed grains are considered by some to be the most important source of food globally.1,2 In fact, wheat is used in a multitude of foods and nonfood items, including some you might not suspect. Although this list includes more obvious items such as cakes, crackers, and cereals, it also incorporates things such as ice cream, hot dogs, cosmetics, and play dough.3 On average, unprocessed wheat grains contain severl nutrients and are 70 percent carbohydrates, 12 percent protein, and 2 percent fat. However, the milling process involved in creating flour eliminates considerable nutritional value.1

Wheat allergy is self reported in an estimated 3.6 percent of Europe's population, it's one of the eight major food allergens in the United States, and it's the third most common food allergy (after milk and egg) in Germany, Finland, and Japan.2,4,5 Children have a higher prevalence of wheat allergy compared to adults, but most outgrow the allergy by the age of 16.6 Note that wheat allergy shouldn't be confused with celiac disease. The former is a food allergy that some people can grow out of, and the latter is a lifelong autoimmune condition triggered by gluten, which can be found in wheat, rye, and barley.7

Where is wheat found?

Wheat can be found in a host of food products including:5 baked goods, baking mixes, bread, bread crumbs, breaded food, breakfast cereal, bulgur, couscous, cracker meal, durum, einkorn, emmer, farina, farro, flour (multiple varieties), matzoh, pasta, seitan, semolina, spelt, triticale, and wheat germ oil.

Additional potential sources of wheat include:2,3,5,7 Asian dishes with wheat flour shaped like animal proteins, batter-fried foods, beer, candy, dairy products such as ice cream, glucose syrup, hydrolyzed vegetable and wheat protein (HVP), imitation crab meat, marinara sauce, meat products such as hot dogs, modified starch and raising agents such as baking powder, natural flavorings, oats, potato chips (crisps), salad dressings, sauces, soy sauce, turkey patties, and vegetable gum.

In some allergic individuals, inhaling wheat flour can also cause a condition that's sometimes called baker's asthma and elicits symptoms of allergic rhinitis (aka hay fever).2,6 The condition's name is derived from the fact that it's a common occupational issue with bakers and those with repeated contact with wheat flour.6

Those with a wheat allergy may also develop allergic urticaria (aka hives) after coming in contact with cosmetics that contain wheat.2 Nonfood items including play dough, bath products, and cosmetics may contain wheat.2,3,5,7

Note that a gluten-free product isn't necessarily wheat free. Rather, the labeling indicates that the item contains a safe level of gluten for those with celiac disease. Since some wheat allergic individuals react to less than 20 parts per million, gluten-free foods aren't considered safe for those with a wheat allergy.7 Buckwheat, however, isn't related to wheat and may be tolerated by wheat-allergic individuals.5

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Are there other allergens I could be sensitized to?*

Some people with wheat allergy may also experience symptoms when eating or being exposed to other seemingly unrelated allergens. This is called cross-reactivity and occurs when your body's immune system identifies the proteins, or components, in different substances as being structurally similar or biologically related, thus triggering a response. The most common cross-reactivities with wheat are other cereals (e.g., rye and barley), rice, maize, and grass pollens.2

Do I need to avoid all forms of wheat?

Wheat consists of different types of proteins that all have different characteristics that may be associated with varying risk of causing severe allergic reactions.2 Knowing the proteins, or components, within each allergen that are triggering your symptoms can help guide your management plan. With that in mind, and based on your symptom history, your healthcare provider may suggest something called a specific IgE component test, which can help reveal your specific risk profile.2

Already have your specific IgE component test results?

Your component test results will include the name of the components (a series of letters and numbers and/or name). Your healthcare provider will likely review the results with you, but here you'll find an at-a-glance breakdown you can use as a reference. Simply match the component names to the list below to see what they mean in terms of symptom management.2

rTri a 14

  • Usually associated with Oral Allergy Syndrome (OAS) and sometimes involves severe reactions. 
  • Stable to heat and digestion, baked wheat may also cause symptoms.

rTri a 19 (Omega-5-gliadin)

  • Usually associated with immediate type wheat food allergy.
  • Usually associated with elevated risk for childhood food allergies, atopic eczema. Allergy is unlikely to be outgrown. 
  • Marker for WDEIA (wheat-dependent exercise-induced anaphylaxis), i.e., risk for severe allergy reactions after ingestion of wheat accompanied by physical exercise, typically in adults.
  • Usually associated with baker's allergy or asthma.
  • Stable to heat and digestion, baked wheat can also cause symptoms.

Gliadin

  • Indicates immediate type wheat food allergy.
  • Usually associated with risk for severe reactions. 
  • Stable to heat and digestion, baked wheat may also cause symptoms.

rPhl p 12

  • Usually associated with mild symptoms, such as OAS.
  • Present in all pollens and plant foods, associated with cross-reactions, typically to birch pollen.
  • Sensitive to heat and digestion; cooked foods are often tolerated.

MUXF3 (CCD)

  • Positive specific IgE for wheat in combination with MUXF3 CCD (Cross-Reactive Carbohydrate Determinant) being the only positive component test indicates that the cause of symptoms may be something other than wheat.

Test results should be interpreted by your healthcare provider in the context of your clinical history. Final diagnosis and decision on further management is made by your healthcare provider.

*These products may not be approved for clinical use in your country. Please work with your healthcare provider to understand availability.

How do I manage my allergy?

Because there is no cure for food allergies, your healthcare provider may recommend a plan that includes the following.12-15

  • Read ingredient labels and "may contain" advisory panels on food and nonfood products carefully, and avoid all foods and products containing any form of the allergen. Note that these lists and panels may not appear on the same side of a product's packaging and that manufacturers frequently change ingredients. If you're unable to obtain a list of ingredients, it's safest to avoid that item.
  • Avoid cross-contamination when cooking by using two sets of cooking and eating utensils, with one exclusively for the allergic individual. Wash all dishes and utensils in hot soapy water between uses.
  • Craft an action plan with a list of steps for you and others to take should you accidentally ingest the allergen. Print out a copy of the plan and carry it with you.
  • Talk with restaurant chefs about your allergy and order food that's simply prepared and void of any form of the allergen. Avoid desserts, as they often contain or have come into contact with food allergens.
  • Plan ahead for traveling to ensure your food allergy will be managed and any emergency medication is always available.
  • Wear a medical ID bracelet identifying the allergen to which you're allergic.
  • Carry any recommended or emergency medication with you at all times.
  • Teach children with food allergies which foods to avoid. Work with caregivers and school staff to eliminate or reduce exposure to the allergen and to ensure they understand when and how to use medication to treat symptoms.

Your healthcare provider may direct you to take one of the following medications:

  • Epinephrine auto-injector when there are signs of an acute severe event, aka anaphylaxis (see below). Ensure your family members know how to administer it in case of an emergency.
  • Antihistamines as a supplement may be useful in relieving mild symptoms (e.g., itch); however, they do not halt the progression of an allergic reaction.
  • Bronchodilator (albuterol) as a supplemental therapy for respiratory symptoms, especially in those with a history of bronchospasm or asthma.

If you're with someone who's having an allergic reaction and shows signs of shock, act fast. Look for pale, cool, and clammy skin; a weak, rapid pulse; trouble breathing; confusion; and loss of consciousness. Do the following immediately:

  • Call local emergency services.
  • Ensure the affected individual is lying down with legs elevated.
  • Administer epinephrine immediately for any obvious signs of anaphylaxis.
  • Check the affected individual's pulse and breathing and administer CPR or other first-aid measures if necessary.

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Wheat Allergen Facts, Symptoms, and Treatment

Common Symptoms

Wheat allergy can range from mild to severe and may vary over time, resulting in mild symptoms during one episode and severe symptoms in another. Although food allergy symptoms can start a few minutes to several hours after ingestion, most begin within two hours.8 Symptoms may involve the skin, gastrointestinal tract, cardiovascular system, and respiratory tract, and may include one or more of the following:8,9

  • Abdominal pain, diarrhea, nausea, vomiting, stomach cramps
  • Hives (allergic urticaria), itching, eczema
  • Wheezing, nasal congestion, shortness of breath, repetitive cough
  • Shock, circulatory collapse
  • Tight, hoarse throat, trouble swallowing
  • Pale or blue skin coloring
  • Dizziness, lightheadedness, fainting, weak pulse
  • Anaphylaxis

Wheat allergy can also result in exercise-induced anaphylaxis, a rare reaction that occurs when the allergen is eaten before exercise. Here symptoms vary from allergic urticaria (aka hives) to anaphylaxis.2

How do I know if I'm allergic?*

Together with your symptom history, skin-prick testing or specific IgE blood testing can help determine if you are allergic to a particular allergen. If you are diagnosed with an allergy, your healthcare provider will work with you to create a management plan.

It's important to note that some children with wheat allergy may outgrow their allergy, and food can be reintroduced. Therefore, periodic retesting and oral food challenges are recommended to track any progress toward outgrowing wheat allergy.11

*These products may not be approved for clinical use in your country. Please work with your healthcare provider to understand availability.

Is there a risk for a severe event?

Because food allergic reactions are unpredictable and symptoms range from local to systemic, it is recommended that an epinephrine prescription be considered for any patient with an IgE-mediated food allergy.12

If you have asthma, you may face a higher risk of severe wheat reactions, particularly if your asthma is poorly controlled.7

  1. Encyclopedia Britannica [Internet]. Chicago: Encyclopedia Britannica Inc.; 2019 Nov 28. Available from: https://www.britannica.com/plant/wheat.
  2. EAACI, et al. Molecular allergology user's guide. Pediatr Allergy Immunol. 2016 May;27 Suppl 23:1-250. doi: 10.1111/pai.12563. PMID: 27288833. (213-223 p.) Available from: http://www.eaaci.org/documents/Molecular_Allergology-web.pdf.
  3. Mayo Clinic [Internet]. Rochester, MN: Mayo Foundation for Medical Education and Research; 2020 Apr 23. Available from: https://www.mayoclinic.org/diseases-conditions/wheat-allergy/symptoms-causes/syc-20378897.
  4. Nwaru BI, Hickstein L, Panesar SS, Roberts G, Muraro A, Sheikh A; EAACI Food Allergy and Anaphylaxis Guidelines Group. Prevalence of common food allergies in Europe: a systematic review and meta-analysis. Allergy. 2014 Aug;69(8):992-1007. doi: 10.1111/all.12423. Epub 2014 May 10. PMID: 24816523.
  5. Food Allergy Research & Education [Internet]. McLean, VA: Food Allergy Research & Education; 2020. Available from: https://www.foodallergy.org/living-food-allergies/food-allergy-essentials/common-allergens/wheat.
  6. Cianferoni A. Wheat allergy: diagnosis and management. J Asthma Allergy. 2016 Jan 29;9:13-25. doi: 10.2147/JAA.S81550. PMID: 26889090; PMCID: PMC4743586.
  7. The Anaphylaxis Campaign [Internet]. Farnborough, UK: The Anaphylaxis Campaign; 2019. Available from: https://www.anaphylaxis.org.uk/wp-content/uploads/2019/07/Wheat-2017.pdf.
  8. American College of Allergy, Asthma & Immunology [Internet]. Arlington Heights, IL: American College of Allergy, Asthma & Immunology; 2014. Available from: https://acaai.org/allergies/types/food-allergy.
  9. Mayo Clinic [Internet]. Rochester, MN: Mayo Foundation for Medical Education and Research; 2019 Nov 2. Available from: https://www.mayoclinic.org/diseases-conditions/food-allergy/symptoms-causes/syc-20355095.
  10. Norges Astma- og Allergiforbund [Internet]. Oslo, Norway: Norges Astma- og Allergiforbund; 2007 Apr 21. Available from: https://www.naaf.no/en/fokusomrader/allergi-og-overfolsomhet/mat-og-matoverfolsomhet/useful-facts-on-wheat-allergy-hvete.
  11. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010 Dec;126(6 Suppl):S1-58.
  12. Wright BL, Walkner M, Vickery BP, Gupta RS. Clinical Management of Food Allergy. Pediatr Clin North Am. 2015 Dec;62(6):1409-24. doi: 10.1016/j.pcl.2015.07.012. Epub 2015 Sep 7. PMID: 26456440; PMCID: PMC4960977.
  13. American College of Allergy, Asthma & Immunology [Internet]. Arlington Heights, IL: American College of Allergy, Asthma & Immunology; 2014. Available from: https://acaai.org/allergies/types-allergies/food-allergy/food-allergy-avoidance.
  14. Harvard Health Publishing [Internet]. Boston, MA: Harvard Medical School; 2020. Available from: https://www.health.harvard.edu/healthbeat/6-tips-for-managing-food-allergies.
  15. Mayo Clinic [Internet]. Rochester, MN: Mayo Foundation for Medical Education and Research; 2019 Sep 14. Available from: https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468.
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