Wheat Allergy In Children

Dr Mohamad Zbib: General Pediatrician, Pediatric Allergy & Pulmonology, Raee Hospital-Lebanon

Gluten has become a popular topic and is being exploited by the food industry. Wheat is the most commonly consumed food. Three wheat related disorders have been described: wheat allergy (WA), celiac disease (CD), and non-celiac gluten sensitivity (NSGS) (4). To understand these allergies more, we need to understand what specific nutrient or ingredient causes them. Wheat proteins (Triticum Oestivum) are classified into two groups according to water solubility (3). 

As compared to other food allergies, wheat allergies are present in less that 0.5% of the populations. It is not common as allergies on milk, egg, peanuts, tree nuts, and sea food. However, it is more common than other cereal grains like barley, rye, oat, rice (4). 

How does wheat allergy in children manifest? It affects the Gastrointestinal tract that causes signs like vomiting, colic, and/or diarrhoea. Besides, this allergy might show some skin signs like eczema or urticaria (4). In addition to that, it might affect the respiratory system manifesting is asthma. Last but not least, it might cause anaphylaxis which could be fatal(4).

This allergy is an IgE mediated immune response type. This means that it can be identified in blood tests like serum wheat specific IgE test (2). It might also be diagnosed by doing a skin prick test by the specialized doctor. This is manifested when wheat is ingested, which causes Eosinophilic Gastroenteropathies: a rare disease of the gastrointestinal tract characterized by crampy abdominal pain, nausea, vomiting, diarrhea, gastrointestinal bleeding, and weight loss (2). It also might manifest when inhaled or by skin contact like in wheat containing cosmetics.

Have you ever heard of “bakers’ asthma”? Occupational exposure to wheat flour may cause asthma with rhinitis in certain workers in bakeries and flour mills (5). 

How about the most severe implications of a wheat allergy in children? Food-dependent-exercise-induced-anaphylaxis (FDEIA) is an unusual form of exercise induced anaphylaxis that occurs only when the patient exercises within 2 to 4 hours of ingesting a specific food. Neither the food intake alone nor the exercise alone can trigger the anaphylactic reaction. Wheat is the most implicated food in FDEIA. Reaction occurs within few hours after eating the food. These persons should exercise delayed 6 hours or more.

Its management follows certain guidelines. Basic management is avoidance of wheat. Epinephrine autoinjector for patients who have history of systemic reaction is also used.
For WDEIA (Wheat-dependent-exercise-induced-anaphylaxis) a species of grain called ancestral wheat flour that does not contain 5-gliadin can be used instead (1).

In conclusion, though wheat allergy is present in than 1% of the society, it should not be taken lightly. Mothers should be aware of all the signs or symptoms of allergy discussed above when their child ingests wheat or any form of wheat and report to their pediatrician in order to follow-up on this issue and be instructed accordingly. However, many industries are using this form of allergy to market their products are better products. In fact, gluten or wheat avoidance should only be practiced by people who have been diagnosed with this form of allergy.

Aptamil is not the author of this article, as it has been written by Dr Mohamad Zbib who is the owner of the content

References:

1. Pastorello EA, Farioli L, et. al. Wheat-dependent exercise-induced anaphylaxis caused by a lipid transfer protein and not by ω-5 gliadin. Ann Allergy Asthma Immunol. 2014; 112(4):386-387.
2. Mäkelä MJ, Eriksson C, et. al. Wheat allergy in children – new tools for diagnostics. Clin Exp Allergy. 2014; 44(11):1420-30.
3. Sandra P, Claudia C, et. al. α-Purothionin, a new wheat allergen associated with severe allergy. Journal of Allergy and Clinical Immunology. 2013; 132(4): 1000-1003.
4. Helm R.M, Burks A.W, et al. Food allergens. Clin Allergy Immunol.2008; 21: 219-235
5. Gómez L, Martín E, et al. Members of the alpha-amylase inhibitors family from wheat endosperm are major allergens associated with baker’s asthma. FEBS Lett.1990; 261(1):85-88.