Bread, pasta and crackers—all the foods that little kids and picky eaters flock to—share one essential ingredient: wheat. The most widely grown crop in the world, wheat is a staple in the Canadian diet. But if your child has a wheat allergy, it can be tough to avoid.
Here’s what you need to know to help keep your child safe if they’re allergic to wheat.
A wheat allergy occurs when your immune system mistakenly identifies a protein in the grain as dangerous, produces allergic antibodies and releases chemicals that cause a reaction. To become allergic to wheat, a child must first be exposed to it. This can happen by eating or inhaling it, being exposed through broken skin (such as eczema) or coming in contact with it in other ways that are not yet understood by the medical community.
“A child may react the first time that a parent can recall feeding the food to their child, but they would have to be exposed to it in some way to develop sensitization,” says Timothy Vander Leek, an Edmonton-based allergist and vice-president of the Canadian Society of Allergy and Clinical Immunology. “You’re not born with a food allergy.”
Having a wheat allergy is fairly rare. Between 0.2 and one percent of children are allergic to wheat, and they’re more likely to be allergic if they don’t start eating it at six months of age. “We think early introduction increases the likelihood that you will develop a tolerance to that food,” says Vander Leek. The Canadian Paediatric Society recommends introducing allergenic foods to infants who are at high risk of developing allergies—those with eczema or a family member with an allergy—at around six months of age. Interestingly, Vander Leek explains that the immune system is primed to think that something that comes in through the skin (such as with eczema) is an invader, while something that comes in through the gut is meant to be there.
Celiac disease involves an immune reaction to gluten, a protein found in wheat, rye and barley. When someone with celiac disease eats gluten, it damages the lining of the small intestine, which can lead to gastrointestinal symptoms, weight loss and malnutrition.
“Celiac disease is a different type of immune response, in which you have a different type of antibody that recognizes that specific protein,” says Vander Leek. “Celiac disease and wheat allergies are completely different conditions that happen to be related to one specific food.”
Celiac disease can develop at any age and lasts for life, while wheat allergies typically show up in the first year of life and the majority of children outgrow them by the time they’re teenagers. The symptoms of both conditions can set in within minutes of consuming wheat and may involve vomiting, diarrhea, tummy aches and irritability. However, the symptoms of a wheat allergy can also involve other body systems and be immediately life-threatening.
Symptoms of a wheat allergy can involve the skin and respiratory, gastrointestinal and cardiovascular systems and typically set in within minutes of exposure and very rarely more than 30 minutes later. Reactions may be different every time a child is exposed to wheat, so it’s important to be aware of all the possible signs. “Allergic reactions are unpredictable and can range from mild to severe,” says Vander Leek. “It’s a myth that food allergies get worse over time.”
Skin symptoms are common and may include hives, swelling and eczema among those with the condition. If a reaction involves the respiratory system, children may experience sneezing, coughing, wheezing and shortness of breath. The most common gastrointestinal symptoms are nausea and vomiting, but children can also have diarrhea. When the cardiovascular system is involved, children may become groggy and lose consciousness.
A severe allergic reaction is called anaphylaxis and is a medical emergency. Anaphylaxis typically comes on quickly and involves two or more body systems, such as the cardiovascular and respiratory systems. “Breathing symptoms and symptoms that affect consciousness are life-threatening,” says Vander Leek. “You can’t die from vomiting or a rash alone.”
A 2013 study found that half of children with wheat allergies have experienced anaphylaxis. Wheat is also a frequent cause of food-dependent exercise-induced anaphylaxis. After intense exercise, children who are known to be allergic to wheat can have more severe reactions and those who can otherwise tolerate the grain may have a reaction for the first time (or in a rare occurrence).
If your child seems to be having a mild reaction to wheat for the first time, such as hives, a runny nose, an itchy tongue or an upset stomach, it’s safe to stay home and watch them closely and see your doctor as soon as possible, says Vander Leek. However, he adds, if the reaction is affecting their breathing or consciousness, you should call 911 and get to the hospital immediately. “If you’re at all concerned or unsure, go to the emergency room,” he says.
At the hospital, your child may be treated with epinephrine, a life-saving drug that stops the reaction. Other medications, such as antihistamines, steroids and drugs to relax the muscles of the airway, may also be given, but they do not replace epinephrine.
Once your child has been diagnosed with a wheat allergy, they should always carry an epinephrine auto-injector (called by the brand name EpiPen in Canada) and everyone who cares for them should know how to use it. At the first sign of a serious reaction, an EpiPen should be given on the outside thigh and 911 should be called. It’s always important to go to the hospital after being treated with an EpiPen because epinephrine wears off after about 20 minutes and the child may need further treatment. “If you’re not sure, it is never wrong to give epinephrine because it will never harm your child,” says Vander Leek.
For mild symptoms, such as itchy skin and sneezing, Vander Leek says you can give them an antihistamine, although some allergists caution against doing so because it may mask the progression of a reaction. Talk to your child’s allergist to see what they recommend. “You should never use an antihistamine for anaphylaxis,” says Vander Leek. “That is absolute.”
While there is no cure for wheat allergies, oral immunotherapy, which involves consuming gradually increasing amounts of the allergen every day to reduce the chances of having a reaction, shows promise in helping children with allergies build up tolerance. A recent clinical trial on wheat oral immunotherapy found that more than half of participants became desensitized after a year of therapy. After two years of treatment and several weeks without taking a daily dose of wheat, 13 percent of participants were able to eat a full serving of wheat without any symptoms. The challenge with oral immunotherapy is that many people experience adverse reactions, including anaphylaxis. In the clinical trial, nearly one-quarter of participants dropped out, primarily due to gastrointestinal symptoms.
When you take your child to an allergist, they will start by asking you questions about your child’s reaction to wheat to see if it’s consistent with a wheat allergy. “The diagnosis of a food allergy is incredibly dependent on the story,” says Vander Leek. “With very few exceptions, it’s inappropriate to proceed with testing if the story is not consistent with a food allergy because it’s very possible to have positive tests to foods that you can eat without any problems.” It turns out, many people make antibodies to foods but can eat them just fine.
If it sounds like your child might have a wheat allergy, the allergist will do a skin prick test, a blood test or both. The skin prick test involves exposing skin to the allergen to see how big of a weal (an area of irritated skin) develops around the site. The larger the weal, the more likely it is that a child is allergic. However, the size of the irritated area does not predict the severity of the allergy. The blood test measures the level of the allergic antibody in the blood and can be done in the years following the initial diagnosis to see if the level has decreased, which may suggest that the child is outgrowing the allergy.
An oral food challenge, during which a child consumes wheat under the supervision of an allergist to see how they react, is considered the gold standard test for food allergies, but it is typically done to see if a child has outgrown an allergy rather than to confirm an initial diagnosis, says Vander Leek.
Wheat shows up in many expected and unexpected products. It’s a standard ingredient in baked goods, such as breads, cakes, cereals, cookies and crackers, and can be found in many kitchen staples, such as baking powder, bouillon cubes and seasonings. A long list of condiments, such as ketchup, mustard, chutney, soy sauce and salad dressings, may also contain wheat. And it can even be in ice cream.
In Canada, if wheat is in a product, it must be clearly labelled on the package, so be sure to always check. However, precautionary labels, such as “may contain,” are voluntary. If you’re worried about cross-contamination in a production facility, check with the manufacturer.
There are many varieties of wheat, so it’s important to be aware of all the names, including spelt, kamut and durum. Triticale is a hybrid grain produced by crossing wheat and rye and should also be avoided. Bulgur and couscous are also made from wheat.
A number of non-food items that kids can get their hands on contain wheat, too, including craft supplies, glue and Play-Doh. If a child gets a wheat-containing product on their skin, it can cause a contact reaction, which may include hives and itchiness. If they eat it, they could experience a severe reaction.
You may even want to reconsider having flour in your home because kids can have reactions to wheat by inhaling it. For example, if you are baking and dump a cup of flour into a mixing bowl, some of the flour could become airborne and be inhaled by your allergic child, potentially causing significant respiratory symptoms.
Fortunately, many children outgrow wheat allergies. One study found that 29 percent outgrow them by age four, 56 percent by age eight and 65 percent by age 12. The higher the level of allergic antibodies in the blood, the less likely a child is to outgrow the allergy, although some children with very high levels do eventually outgrow it.