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Food allergies affect about 8% of infants and wheat allergy is one of the most common allergies among children, though it can also occur in adults (Pourpak et al, 2004). Allergic reactions can occur in a few minutes to a few hours in some individuals after they’ve consumed wheat. These reactions include: skin rashes, congestion, digestive issues, and even anaphylaxis.

This allergy, like all food allergies are caused by failure on the immune system. The ingestion of the wheat proteins triggers the immune system to identify them as harmful and the IgE antibodies are secreted to neutralize the proteins. Thus, the antibodies signal the body to secrete histamine and other chemicals, resulting in the severe reactions (Tortora et al, 2007).

There are certain risk factors that put individuals above others for wheat allergies that must be taken into account (MayoClinic Staff, 2007):

  1. Family history—if allergies are prevalent in the family (hay fever, hives, asthma, etc.), then individuals are placed a higher risk of developing wheat and other food allergies

  2. Age—this type of allergy is most common among children

Gluten is the recognizable protein in wheat that is a contributing factor to the development of wheat allergies. It is further broken into two separate components: gliadin and glutenin. Gliadin will be the main focus due to the breakthrough research that has been conducted on it to formulate more efficient treatments for this allergy.


Allergen: Gliadin


When analyzing wheat allergy effects in children, gliadin came to researchers’ eyes immediately. For a while, there has been little information regarding allergens that are responsible for these hypersensitivity reactions in children from ingesting wheat. Allergens speculated to have a role in these reactions, especially anaphylaxis, include gliadin—specifically ω-5 gliadin. Researchers then conducted a study to see whether children with wheat allergies contained the antibodies against this type of wheat protein. The results were definitely expected. ω-5 gliadin is a specific allergen in young children with immediate allergic reactions to ingested wheat. Thus, IgE testing for this specific antigen could be used to minimize the need for oral wheat challenges in children to diagnose wheat allergy (Palosuo et al, 2001).


Celiac disease


People who cannot tolerate this wheat allergen can also develop celiac disease, which is a digestive disease that manipulates the small intestine and interferes with the absorption of food. When people eat foods containing wheat proteins, like gluten, the immune system responds by destroying the villi that line the small intestine. These finger-like protrusions normally allow nutrients from food to be absorbed through the intestinal walls and into the bloodstream. Consequently, people with celiac can become malnourished no matter how much food they eat.

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Figure 1: Small intestine darkened



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Figure 2: Intestinal walls with villi

In contrast to just having wheat allergies, this disease is purely genetic and can occur in individuals with other types of immune-related diseases like autoimmune thyroid disease, liver disease, rheumatoid arthritis, etc. Failure to diagnose and treat can result in developments of osteoporosis, anemia, and cancer ("Celiac Disease," 2008).


Treatment options


Even though wheat allergies can lead to these serious diseases and prove difficult to manage in a carbohydrate-filled world, there are adequate options available.

Epinephrine is extremely necessary for individuals with severe allergic reactions if they ingest wheat. The medication is injected into the skin and it stops airways from swelling up and make breathing difficult. Prescription or over-the-counter antihistamines are suggested for those who suffer asthma-like symptoms after ingesting wheat. They will help off-set symptoms like wheezing and nasal congestion. It really isn’t all that uncommon for wheat allergy sufferers to have asthma as well, so they must carry an inhaler at all times.

Yet, probably the most effective treatment is to adopt a strict gluten-free diet. Check labels in the grocery stores, ask restaurant staff about the menu’s ingredients, and learn alternative names that indicate the presence of wheat (e.g. barley malt in beer). Nowadays there are dozens of gluten-free options available like rice pasta, corn flour, molasses, etc. Researchers are optimistic though that in the future, there will be better treatment options available to permanently desensitize individuals suffering from wheat and other various food allergens (Sicklick et al, 2006).


What To Eat, What Not To Eat...That Is The Question!



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Allowed

Not Allowed

What To Watch Out For

Legumes
Semolina
Soy Sauce
Nuts
White flour
Soups
Rice
Enriched flour
Rice mixes
Quinoa
Graham flour
Chips
Arrowroot
Barley
Hot dogs
Corn
Rye
Cold cuts
Seeds

Brown rice syrup
Soy

Gravy
Tapioca

Candy
("Allergy & Asthma: Wheat Diet," 2007)


Diagnostic practices and proposals


One of the most common ways to detect wheat and other food allergies is to perform a skin prick test. This test involves mixing suspected causes of allergy (e.g. wheat proteins) with liquid to make an allergen solution. A drop of solution is then placed on the forearm of the patient and the skin beneath the drop is pricked. Two types of reactions can occur ("Skin Prick Allergy Test," 2006):

  1. Positive reaction—the skin under the drop becomes red and itchy and a white, raised swelling called a weal surrounds the area. The weal eventually fades away after a few hours

  2. Negative reaction—the skin remains normal



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Figure 3: Skin prick test procedure

Another diagnostic tool is the oral food challenge. A patient must reduce consumption of antihistamine medications prior to taking the test and should only take it if the physician deems it necessary—especially those at risk for anaphylactic shock. The test uses capsules of foods believed to contain the allergen and are taken like pills by the patient. The physician monitors periods after each dose that the patient takes to determine whether or not an allergic reaction has taken place. Even though this test is highly accurate, it is very time-consuming and risky to perform (Sicklick et al, 2007).

As stated before with the case of detecting high levels of gliadin antibodies in patients, presence of wheat-specific IgE can provide more accurate results in predicting the severity of allergic symptoms—especially in the cases of patients with anaphylaxis.


Conclusion


Food allergies have been strongly underestimated in terms of their occurrence and severity. This is why early detection is so crucial to the prevention of related deaths and even connected diseases such as celiac. Research continues to be conducted in order to better implement prevention procedures and treatment options for patients—especially children. Thankfully, diet options are available for many, particularly those suffering from wheat allergies, and prove to be worthwhile and manageable. Still, it is extremely important to implement early detection practices and have constant awareness. The allergy may seem minor but sometimes a little taste is all it takes.

Literature Cited


"Allergy & Asthma: Wheat Allergy Diet." University of Virginia Health System. 2007. 25 April 2009 <http://www.healthsystem.virginia.edu/uvahealth/adult_allergy/wheat.cfm>

"Celiac Disease." National Digestive Diseases Information Clearinghouse (NDDIC). 2008. 25 April 2009 <http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/>

Mayo Clinic Staff. "Wheat Allergy." MayoClinic.com: Mayo Foundation for Medical Education and Research (MFMER). 2007. 23 April 2009 <http://www.mayoclinic.com/health/wheat-allergy/DS01002/METHOD=print>

Palosuo, K., Varjonen, E., Kekki, O., Klemola, T., Kalkkinen, N., Alenius, H., and Reunala, T. 2001. "Wheat ω-5 gliadin is a major allergen in children with immediate allergy to ingested wheat." Journal of Allergy and Clinical Immunology. 108: 634-638.

Pourpak, Z., Mansouri, M., Mesdaghi, M., Kazemnejad, A., and Farhoudi, A. 2004. "Wheat Allergy: Clinical and Laboratory Findings." International Archives of Allergy and Immunology. 133: 168-173.

Sicklick, M (reviewer). "Food Challenge Test." Your Total Health. 2007. 23 April 2009 <http://yourtotalhealth.ivillage.com/food-challenge-test.html>

Sicklick, M (reviewer). "Wheat Allergy." Your Total Health. 2006. 23 April 2009 <http://yourtotalhealth.ivillage.com/wheat-allergy.html?pageNum=6#6>

"Skin Prick Allegy Test." Patient UK. 2006. 25 April 2009 <http://www.patient.co.uk/showdoc/27000428/>

Tortora, G., Funke, B., and Case, C. "Chapter 19: Disorders Associated with the Immune System." Microbiology: an Introduction, 9th ed. San Francisco: Pearson Benjamin Cummings, 2007.

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For more information about wheat allergies, check out these links:


1. Johnson & Johnson Health Channel video about wheat and other food allergies:
Johnson&Johnson: Food Allergies

2. Food Allergy Initiative information webpage with advice on those suffering from wheat allergy
Wheat Allergy

3. Delicious gluten-free recipes!
Celiac Sprue Association