The U.S. Department of Agriculture (USDA) recognizes wheat as one of the “Big 9” major food allergens. More than 13,000 members of the MyFoodAllergyTeam community report being allergic to wheat.

Wheat is an ingredient used to make breads, pastas, cookies, and many other commonly eaten foods. In addition to showing up in obvious foods made with wheat and wheat flour, the food allergen often also pops up in unexpected places, like sauces and salad dressings. This can make it tricky to avoid wheat completely. But the good news for people living with a wheat allergy is that effective treatment may be just around the corner.

Here are nine facts you should know about wheat allergy, including common symptoms.

1. You Can Be Allergic to Different Wheat Proteins

When you have a wheat allergy, your body’s immune system misidentifies wheat as something that’s trying to harm you. The immune system is a combination of white blood cells, organs, proteins, and chemicals that fight bacteria and other foreign invaders to keep you healthy. In other words, it’s your body’s defense system against illness and injury.

If you have a wheat allergy, any of the four types of protein in wheat — albumin, gliadin, globulin, and gluten — can trigger an allergic response. When you eat wheat, your immune system overreacts, trying to fight off the protein that it has decided is trying to hurt you.

2. Wheat Allergy Can Cause Various Symptoms

Wheat can trigger two types of immune responses — immunoglobulin E (IgE) mediated and non-IgE mediated. When IgE — an antibody made by your immune system — is involved, your immune system produces specific IgE antibodies to target wheat. IgE antibodies bind to a wheat protein, which prompts your immune system to fight and defend you from harm. This overreaction by the immune system is what triggers allergic reaction symptoms.

With IgE-mediated wheat allergies, it’s common to develop symptoms within several minutes of eating or inhaling wheat. But it’s also possible for symptoms to present as much as four hours later. Symptoms may be mild, moderate, or severe.

Common symptoms of a wheat allergy include:

• Hives (itchy welts), skin rash, and swelling
• Digestive symptoms like abdominal pain, stomach cramps, and diarrhea
• Nausea with or without vomiting
• Headache
• Nasal symptoms like a runny or congested nose or sneezing
• Wheezing
• Symptoms of anaphylaxis (a life-threatening allergic reaction) like swelling of the airways, shortness of breath, and trouble breathing

Non-IgE reactions are immune responses to wheat that don’t involve IgE antibodies. In general, symptoms take longer to develop with non-IgE allergies. People may experience symptoms hours or even days after eating wheat. Non-IgE wheat allergies can lead to inflammation in the stomach or esophagus (tube between the mouth and stomach).

For some people, wheat may trigger anaphylaxis — a severe allergic reaction that requires immediate medical treatment. One review reported that wheat was found to be the most common food to trigger anaphylaxis for adults in Europe and the leading cause for adults and children in China. People with wheat-dependent, exercise-induced anaphylaxis develop a severe allergic reaction only if they exercise within a certain time frame after eating wheat.

3. Wheat Allergy Isn’t the Same as Celiac Disease

Many people confuse wheat allergy with celiac disease, but they’re not the same thing. Although wheat allergy and celiac disease both cause an immune response, they’re triggering different types of reactions.

Celiac disease isn’t a gluten allergy, it’s an autoimmune disease. When someone with celiac disease eats wheat, their immune system tries to attack the gluten protein. This leads to inflammation in the small intestine and damage to its lining, which is responsible for absorbing nutrients as food is digested. Celiac disease often involves the digestive system and causes symptoms that include:

• Bloating
• Constipation
• Diarrhea
• Abdominal pain

Other symptoms may include weight loss due to lack of nutrients.

Nonceliac gluten sensitivity and gluten intolerance can cause digestive symptoms, fatigue, and sometimes dizziness. But these types of gluten sensitivities don’t cause damage to the intestines or affect nutrient absorption.

4. Your Diagnosis May Vary Depending on Your Symptoms

There are different ways to diagnose a wheat allergy. Your allergist will likely use a combination of physical exam, allergy testing, and the medical history you provide to diagnose you. Depending on your symptoms, your allergist may perform the following tests to diagnose a wheat allergy:

• Skin prick tests — A small amount of wheat proteins is placed on the skin before or after you receive a light prick or scratch with a small needle. A raised, discolored circle at the site of exposure indicates a positive result.
• Blood tests — A sample of your blood is exposed to wheat proteins to measure the level of wheat-specific IgE antibodies.
• Oral food challenge — You’ll eat small amounts of wheat in the safety of your allergist’s office to gauge your reaction. This is typically done if you’re not at high risk of having a life-threatening reaction and your skin prick and blood test results haven’t provided a clear diagnosis.

In some cases, your healthcare provider may ask you to try an elimination diet — or remove wheat from your diet to see if that helps your symptoms. You may also be asked to keep track of everything you eat in a food diary to help your doctor identify what’s behind your symptoms.

5. You’ll Need To Avoid Wheat Completely

To manage a wheat allergy, avoiding wheat is crucial. In addition to recommending a wheat-free diet, your provider will also likely prescribe medications in case you’re accidentally exposed to wheat. Antihistamines or corticosteroids (also called steroids) may be prescribed for people with less severe wheat allergy. Epinephrine injectors are often prescribed for people with severe allergies who are at risk of anaphylaxis.

6. Avoiding Wheat Can Be Tricky

The U.S. recognizes wheat as a top allergen, and companies are required to declare wheat as an ingredient on product packaging. But avoiding products that contain wheat is often easier said than done. Although some sources of wheat are more obvious, like pasta and breadcrumbs, there are many other types of foods and products that include wheat that might surprise you.

Some less obvious sources of wheat may include:

• Beer and ale
• Breakfast cereals
• Grains, such as couscous, farro, and spelt
• Hot dogs
• Ice cream
• Potato chips
• Processed meats, such as sausage
• Salad dressings
• Sauces, such as soy sauce
• Seitan
• Soups
• Nonfoods, such as personal care products and modeling clay

Due to the sheer amount of products wheat can be found in, avoiding it can be hard. It’s essential to check food labels before eating.

7. You Have To Be Careful of Cross-Contact

Even if wheat isn’t used as an ingredient, how and where food is prepared can allow for cross-contact with wheat. For example, if normally wheat-free potato chips are made on an assembly line that also processes wheat-based snack foods, wheat proteins may be transferred. This transfer renders the formerly gluten-free snack no longer gluten-free, which means it may lead to an allergic reaction in someone with a wheat allergy. To avoid cross-contact, make sure to check food labels to see whether food was made on shared equipment that also processes wheat.

Having a wheat allergy can also make it challenging for someone to eat at restaurants, school, or anywhere their food is being prepared for them. Although many restaurants provide allergen labelling on their menus, many don’t. Some mobile apps can help you to find gluten-free restaurants and allergy-friendly kitchens that are safe for eating out. Always inform your server of your allergy, ask questions about food preparation, and carry emergency treatments like epinephrine with you whenever you go in case you’re exposed.

8. Wheat Allergy Is More Common in Children

Children, especially young children, are more likely to have a wheat allergy than adults. The food allergy is estimated to affect around 1 percent of U.S. children. That said, research shows that wheat allergy is commonly outgrown as children get older. Evidence has shown that two-thirds of children will outgrow their wheat allergy by age 12, while 80 percent will shed the food allergy by age 16.

Although many children outgrow their wheat allergy, this isn’t always the case. For some, wheat can be a lifelong food allergy. In total, wheat allergy is thought to impact between 0.2 percent and 1.3 percent of people worldwide.

9. Treatment May Be Around the Corner

Research is underway to find an effective treatment for food allergies. One specific treatment that has shown a lot of promise is oral immunotherapy (OIT).

With OIT, people with a food allergy eat a very small amount of the food they’re allergic to each day — this is a tiny amount, too small to cause an allergic reaction. Over time, this amount is increased with the goal of desensitizing the immune system. In other words, OIT helps to increase the amount of food allergen the body can tolerate before an allergic reaction occurs. Although OIT isn’t a cure for food allergies, it can help protect someone with a food allergy from reacting to accidentally eating a food they’re allergic to. This may allow people with a food allergy, such as wheat, to live with fewer limitations on what they can eat and less stress around food and its preparations, as well as increase quality of life.

Current studies suggest that wheat oral immunotherapy is effective and generally safe. However, it is a balancing act — higher doses work better but cause more side effects, so researchers are still working to find the ideal treatment plan.

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