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Like all food allergies, diagnosing a wheat allergy starts with a physical examination and, of critical importance, a food-allergy-focused patient history.6,7
The findings of this wheat-allergy-focused patient history can then be used to guide testing decisions and results interpretation. This systematic approach can help determine whether the reported history of food allergy, combined with specific IgE test and/or skin-prick test, is sufficient to diagnose food allergy, or if an oral food challenge (OFC) should be considered.3,5,8
Wheat allergy is one of many gluten-related disorders.1 There are three major wheat-related food illnesses: wheat allergy, celiac disease, and non-celiac gluten sensitivity (NCGS).4 The thin line between wheat allergy, celiac disease, and NCGS is not always clearly distinguishable, which can make it difficult to differentiate between these disorders.2
Although there might be an overlap in the symptoms associated with wheat allergy, celiac disease, and NCGS, the conditions have distinct characteristics, as different mechanisms are involved.3,4 Wheat allergy is distinct from both celiac disease and NCGS in that it is an IgE-mediated response that occurs within minutes to hours of wheat ingestion.4
Guidelines recommend that food allergies, including wheat allergy, should be considered in patients presenting with anaphylaxis or a combination of clinical symptoms occurring within minutes to hours after ingesting food, especially in young children or if it is the second episode after the ingestion of specific food.3
Additionally, as wheat allergy’s distinction from both celiac disease and non-celiac gluten sensitivity is that it is an IgE-mediated response, testing can help determine whether the symptoms are actually due to a wheat allergy or another disorder on the gluten-related spectrum.4
A thorough knowledge of the differences and overlap in clinical presentations among gluten-related disorders can help clinicians in
the process of differential diagnosis following a correct flow chart.
Diagnosis of gluten-related disorders:
A gluten free diet
Diagnosis of gluten-related disorders:
A gluten containing diet
Food allergy, including wheat allergy, can have a dramatic effect on quality of life.10 Many studies have detailed the negative effect of food allergy on health-related quality of life (HRQoL), as well as the financial and emotional toll a food allergy takes.8 Identified issues include feeling different because of the diet, worrying about foods, the presence of physical and emotional distress, increased responsibility, effect on social activities (social restrictions, school, travel, and dining out), anxiety, stress, bullying, and having to consistently exercise greater caution.8
Many foods may contain wheat, including:11
Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.i,ii Diagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.iii,iv
i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.
ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331
iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.
iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238
Management of wheat allergy is mainly based on avoidance of wheat both in food and inhaled wheat allergens.5 Patients with a food allergy to wheat must be trained to identify relevant food allergens in the labels, and written instruction should be given to help eliminate wheat from their diet.5 In case of accidental exposure and anaphylactic reaction for all forms of wheat allergy, an epinephrine auto-injector can be a lifesaving treatment.5
Practice parameters have been developed to help guide the management and treatment of patients with food allergies, including wheat.