Wheat Allergy: Symptoms, Diagnosis, and Management

Wheat allergy is an IgE-mediated hypersensitivity to wheat proteins (gliadins, glutenins, albumin, globulin). Distinct from celiac disease (autoimmune, anti-tTG) and non-celiac gluten sensitivity.

Clinical Manifestations

Anaphylaxis: Multi-system, rapid onset; wheat-dependent exercise-induced anaphylaxis (WDEIA) – ω-5 gliadin + exercise.

System	Symptoms
Cutaneous	Urticaria, angioedema, atopic dermatitis flare
GI	Nausea, vomiting, abdominal pain, diarrhea
Respiratory	Rhinitis, asthma, laryngeal edema

Diagnosis

• History + skin prick test (commercial extract) or specific IgE (ImmunoCAP).
• Component-resolved diagnostics (ω-5 gliadin, Tri a 19) improve specificity.
• Oral food challenge (gold standard) if equivocal.

Management

• Strict wheat avoidance (read labels: “wheat,” “flour,” “semolina,” “spelt,” “kamut,” “farro”).
• Epinephrine auto-injector if history of anaphylaxis/WDEIA.
• Nutritional counseling: replace B vitamins, iron, fiber from fortified wheat.
• Re-evaluate periodically; ~65% children outgrow by adolescence.

Cross-Reactivity

Barley, rye, oats (contamination) may trigger reactions in some; test individually.