Wheat Allergies

Overview:

Bread, pasta, and most batter-fried dishes are but three of the common foods off-limits to people with wheat allergies. Wheat allergies are among the eight most common food allergies, affecting as many as six percent of children under the age of three (they are much less common among adults). Celiac disease, an autoimmune disorder affecting the body's ability to process gluten proteins found in wheat and some other grains, is not a form of wheat allergy, though people with celiac disease and people with wheat allergies have similar dietary restrictions.

Wheat Allergy Symptoms:

While wheat allergies can cause many symptoms, wheat allergies are most commonly associated with three classic allergy symptoms: asthma, eczema (or atopic dermatitis), and, rarely, anaphylaxis. Wheat is also a recognized cause of exercise-dependent anaphylaxis, in which the combination of an allergen and physical exertion triggers anaphylactic shock. Anyone whose allergist suspects them to be susceptible to exercise-dependent anaphylaxis should always exercise with a partner who recognizes anaphylaxis symptoms in addition to avoiding wheat.

Cross-Reactivity:

Wheat is considered especially likely to cross-react with barley, although most people with wheat allergies are able to consume other grains.

Wheat Allergies and Celiac Disease:

While celiac disease and wheat allergies arise from different processes in the body, they are related in their implications for patients' lifestyles. People with wheat allergies and celiacs must strictly avoid all wheat in the diet. (Celiacs must avoid rye and barley as well.) Many people with wheat allergies are sensitive to the same proteins (glutenin and gliadin) as celiacs, although other proteins in wheat can trigger allergies.

Wheat Allergies and Labeling Laws:

Because wheat is one of the eight most common food allergens in the United States, the FDA requires food manufacturers to label its presence clearly on food labels. This will either be as the word "wheat" in the ingredient list, or following the word "Contains" after the list.

There is no legal definition for the term "gluten-free" in the United States, but the vast majority of foods on the market with that indication are indeed wheat-free. European products labeled gluten-free follow the Codex Alimentarius, and may contain minute amounts of wheat unless labeled "gluten-free, wheat-free" or "naturally gluten-free."

Foods Commonly Containing Wheat:

Wheat is a staple grain in many Western countries and is present in a wide variety of foods. Here are some foods that are especially likely to contain wheat:

• All baked goods (including bread and pizza crusts), unless prepared with wheat-free flours
• Pasta, whether egg-free or not
• Some baking powders
• Most batter-fried foods
• Flour-thickened sauces, casseroles, and gravies
• Canned soup and chili
• Cereal (both hot and cold)
• Salad dressings, barbecue sauce, soy sauce and other condiments
• Beer
• Candy (especially with nougat)
• Sausage, meatloaf, and other dishes where breadcrumbs are used as a filler

Eating Out with Wheat Allergies:

Chain restaurants often include wheat and gluten information on their websites, and some, like P.F. Chang's, even offer wheat- and gluten-free menus. Here are some rules of thumb for ethnic cuisine:

• Italian is difficult, but risotto and polenta may be safe.
• French and Continental cuisine are difficult. Stick to plain grilled or sauteed meats, potatoes, and vegetables.
• Thai is the safest East Asian food, as Thai soy sauce is traditionally wheat-free (check labels, though!). Sushi is simple; bring safe soy sauce and avoid ponzu.
• Mexican and Latin American are relatively easy. Avoid fried foods and flour tortillas.

Where to Find Wheat-Free Products:

Whole Foods Market is a reliable source for wheat-free products, as they operate a gluten-free bakery of their own and distribute excellent (albeit expensive) wheat-free bread, pastries, ready-to-top pizza crusts, and scones to their stores. They also carry a wide selection of wheat-free products from other manufacturers. Larger supermarkets, too, increasingly offer a decent selection of wheat-free products, usually in the health food section. If you're having a hard time finding wheat-free staples where you live, look online: Gluten-Free Mall, Gluten-Free.com, and Miss Roben's.

Spelt, Kamut, and Other "Wheat Alternatives":

Spelt and kamut are commonly sold as wheat substitutes and touted as safer for people with wheat allergies. However, this is likely not the case. Kamut is a subspecies of wheat, and there seems to be no difference between kamut and wheat from an allergy perspective. Spelt is a close relative of wheat (in the same genus, though not the same species), and older research has shown gliadin proteins in spelt -- the same proteins that often trigger wheat allergies.

Grains that are not close relatives of wheat include amaranth, buckwheat, quinoa, corn, rice, arrowroot, tapioca, oats, and millet.

Living with Wheat Allergies:

The bad news about living with wheat allergies is that wheat is a pervasive allergen, especially in the Western diet. In addition to being a staple dietary grain, it's also a common hidden allergen, especially in hair products and arts and crafts materials.

There is good news, however. Because products for wheat allergies, celiac disease, and gluten-free/casein-free diets for autism are viewed as a much more profitable business niche than most other restricted diets, it is far simpler to find wheat-free products both online and at major supermarkets than products for many other food allergies. Here are some resources you might find especially useful:

• About.com's Celiac Disease Guide offers a Food Shopping for Celiacs guide that you may find useful.
• Wheat-free pasta is widely available, and is made from a variety of grains (quinoa, corn, potato, rice, and beans). Each alternative grain has its own quirks, but in general they make good substitutes for wheat pasta (although they don't always reheat well).
• Wheat-free baking mixes for breads, pancakes, pizza crusts, cakes, and similar items are distributed by Bob's Red Mill, Cherrybrook Kitchen, Authentic Foods, and Pamela's.
• Ready-to-eat and frozen wheat-free foods and snacks are made by Ian's, Glutino, Kinnikinnick, Amy's, and Pamela's, among others.

Proper management of wheat allergies depends both on avoiding wheat and on treating allergy symptoms properly in the event of inadvertent exposure. If your doctor prescribes an Epi-Pen for possible anaphylaxis, be sure to learn the signs of anaphylactic shock and to carry the medicine with you (or a responsible adult, in case of a young child) at all times. Likewise, if your primary symptom is asthma, be sure to keep your rescue inhaler with you and to follow any other instructions your allergist may have given you for asthma management.