3-5 children in every 1,000 in Europe can have wheat allergy. It is seen most commonly in infants and preschool children.
Reactions may be immediate occurring within minutes of exposure and include an itchy rash (hives), swelling, vomiting, diarrhoea, runny nose and itchy eyes. Severe reactions are much less common, but can include difficulty in breathing (with wheeze or swelling in the throat), feeling faint or dizzy. Some people develop symptoms with wheat only after vigorous exercise (exercise-induced allergy).
Reactions may also be delayed by a number of hours and include tummy pain, vomiting, diarrhoea and worsening of eczema. Another form of delayed reaction to wheat occurs in Coeliac disease or gluten intolerance. People with Coeliac disease do not get hives or breathing difficulties but can have belly aches, diarrhoea or generally feeling run down.
Most people with wheat allergy only have mild reactions. Severe reactions affecting the child’s breathing can occur, particularly in those with bad asthma and these need urgent medical attention.
It is important to always read the ingredient list carefully. Products like breaded cheese, sausages, beef burgers, Quorn (used as meat substitute), gravy granules, stock cubes, soya sauces and beverages (malted milk, Ovaltine,) can contain wheat.
Sometimes a label may not specify wheat but another form of wheat like bran, semolina, couscous, rusk or flour. Oil that has also been used to fry food containing wheat like fish fingers can lead to a reaction. People allergic to wheat need to be aware of the risk of cross- contamination in restaurants, bakeries and loosely sold products.
Most children can tolerate corn, rice, oats, barley, buckwheat, tapioca, sago and quinoa (keen-wa). Advice from a dietitian is important and should be arranged.
The diagnosis of wheat allergy is based on the history of a typical reaction after contact with wheat.
Positive allergy tests (skin prick or blood IgE) support the diagnosis where symptoms come on immediately or with exercise, but should not be used alone, as people can have positive allergy tests but tolerate the wheat without getting a reaction. Skin prick tests are safe and can be done in clinic provided that the child has not had any antihistamines for a few days. Blood tests are not affected by antihistamines, but the results are only available in a week or so after the clinic appointment. If the diagnosis is uncertain an oral wheat challenge is sometimes recommended.
It is advisable to wean babies to solid food at 4-6 months of age.
There is no scientific evidence to suggest that delaying giving wheat to babies any later than this age will protect them from this allergy.
A written management plan will be provided and appropriate medication prescribed which should be available at all times.
If wheat is accidentally eaten spit the food out straight away and give an antihistamine as soon as possible.
- Difficulty breathing (wheezing, noisy breathing)
- Swelling in the throat (noisy breathing, drooling)
- Feeling faint or dizzy, looking very pale (lie the child down with their legs raised).
If any of these severe symptoms occur get help straight away and dial 999 stating “anaphylaxis” (ana-fil-ak-sis).
It is important to inform the nursery/school and any after school clubs. Any other carers such as grandparents, relatives and school friends’ parents will also need to know.
About 70% of children will outgrow the problem by 6 years and 96% outgrow the allergy by 16 years. If there has been no reaction for a long time then an oral challenge may be suggested.
Some patients (not those with Coeliac disease) can tolerate a little wheat, in which case they may outgrow their allergy more quickly. Advice should always be sought from your doctor or dietitian before trying to introduce any wheat back into your child’s diet.