Diet, wheat free

Related Terms

Bulk, colon cancer, constipation, diet, dietary fiber, diverticulosis, exercise induced allergy, food allergy, gastrointestinal, gluten, high fiber, insoluble fiber, irregularities, roughage, soluble fiber, wheat, wheat flour, whole grain, wheat, wheat germ.

Background

The wheat free diet is a way of eating where all products containing wheat are eliminated. Such products may include wheat proteins like wheat flour, pasta, semolina, bulgur, couscous, bread, muffins, hydrolyzed vegetable protein, and crackers. Individuals who experience allergic symptoms after ingesting wheat products often use this diet. Some people allergic to wheat may also be allergic to gluten, and thus must place significant restrictions on their dietary intake.
Wheat allergy refers specifically to adverse reactions involving immunoglobulin E (IgE) antibodies to one or more protein fractions of wheat, including albumin, globulin, gliadin and glutenin (gluten). The majority of IgE-mediated reactions to wheat involve the albumin and globulin fractions. Gliadin and gluten may also induce IgE-mediated reactions rarely.
The incidence of wheat allergy has been investigated over the last few decades in an attempt to learn more about the specific interactions between wheat proteins and immunoglobulins. Current research indicates that wheat proteins are very allergenic, meaning that even extremely small amounts are capable of activating the immune response in allergic individuals. Currently, there are no accurate figures describing the prevalence of wheat allergy. Clinical experience suggests that wheat allergy is relatively uncommon. However, it may be more common in certain subgroups e.g. wheat allergy is responsible for occupational asthma in up to 30% of individuals in the baking industry.
However, wheat is among 1 of 6 products that are responsible for about 90% of all food allergies. Seen most commonly in infants and young children, wheat allergy can also occur in adults. The most widely used method to diagnose a wheat allergy is a skin patch test conducted by a qualified health care professional, where small amounts of the suspected allergen are applied to the skin or injected subcutaneously. A positive result would be a localized allergic reaction that indicates the presence of a true, or immune-mediated, allergy.
Symptoms of wheat allergy can vary among individuals, ranging from bothersome but relatively unserious symptoms such as rash, hives, or gastrointestinal distress to a life threatening anaphylactic reaction. In many instances, allergic symptoms do not appear until after physical exertion, and is referred to as an exercise induced allergy. This may make a true allergy difficult to recognize.
There has been a recent increase in cases of documented wheat allergy among children and adults. This may be due to self-reporting of symptoms and may not accurately represent the true number of individuals with an allergy to wheat. However, efforts to manufacture wheat-free products are on the rise. Spelt is a grain used to make baked goods that has been substituted successfully for wheat in allergic individuals. Alternate forms of flour derived from grains such as kamut and chickpeas are available at specialty markets. Dietary staple foods such as pasta may be easily replaced with rice to create a balanced meal while adhering to the wheat free diet.
For those with allergies to wheat or those with Celiac disease (an inherited genetic disorder that causes inflammation of the intestinal lining in response to the ingestion gluten, found in wheat) the wheat free diet is successful in keeping symptoms at bay. The wheat free diet has also been studied for treatment of steatorrhoea (an excess of fat in the stools). More high-quality trials are needed to make any firm recommendations regarding the long-term safety and efficacy of this diet for the treatment or prevention of other conditions.

Theory / Evidence

Infants and children are more likely to be allergic to wheat than adults. In many instances, allergies can be outgrown and wheat products can be tolerated later in life. Some evidence exists suggesting that infants who are not fed wheat products until after six months of age are more likely to develop an allergy to wheat.
Benefits and consequences of eliminating wheat from the diet in those without wheat allergies are unknown. The wheat free diet has only been studied in allergic individuals. Products made from wheat are generally a good source of fiber, so if an individual decides to adopt the wheat free diet he or she must ensure they are meeting nutritional requirements recommended by the American Dietetic Association (ADA).
Many, but not all, wheat allergies are IgE mediated, which often renders skin testing an unreliable method of detecting sensitized individuals.
A study published in early 2006 by Scibilia et al. found that wheat can be the cause of a real food allergy in adults, however no form of allergy testing is completely accurate in diagnosing such an allergy. More than a quarter of the patients allergic to wheat reacted to less than 1.6g wheat. Specific IgE testing was more sensitive than skin testing; however, specificity and predictive values were low for both tests. Thus, the authors concluded these tests should not be used to validate diagnosis of wheat allergy.
Some people choose to manage symptoms of wheat allergy with homeopathic remedies. As with the use of any drug or supplement, this may result in additional health consequences. Currently, the only effective method of managing a true wheat allergy is avoidance of any product containing wheat.
The accidental consumption of wheat in an allergic individual can be extremely dangerous. A physician should be notified in any case, and if trouble breathing develops the individual should seek immediate medical attention.
People who are allergic to wheat are sensitive to one of the proteins found in wheat. Exposure to wheat dust can cause respiratory symptoms including asthma in susceptible people. In rare cases, application of hydrolyzed wheat in body cream has caused hives.
Type I wheat ingestion allergy is a special type of food allergy because the patient usually is not aware of his allergy. The unawareness comes from two reasons; one is that the clinical symptom appears not immediately after ingestion of wheat products but occurs sometime (30-60 min) later, and the other is that it may not appear if the patient does not exercise at this particular time. Therefore, the reaction does not always follow wheat ingestion. The study of enzymatically digested gluten antigens in the patients disclosed that the allergenicity to wheat was reinforced by peptic digestion but abolished by further tryptic digestion, indicating that allergen activity was most potent in the stomach. Anaphylaxis may occur in some patients after wheat ingestion and exercise. Therefore, in exercise-induced anaphylaxis without apparent allergy, one should consider wheat allergy.

Author information

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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Diet outline

Following the wheat free diet involves eliminating all wheat products from the diet. This requires careful attention when reading food labels. Some manufacturers require provide information on their products indicating if contamination with wheat is possible, but this is not always the case.
Individuals are advised to read labels and be able to recognize wheat constituents as ingredients. Alternative food items exist for those wishing to exclude wheat from their diets and are available at most specialty and natural food stores.
Currently, the only effective method of managing a true wheat allergy is avoidance of any wheat-containing products. Some evidence suggests that certain antihistamine medications such as fexofenadine (Allergra) may prevent allergic symptoms when taken before ingestion of wheat in patients with a mild allergy.