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Raising Healthy Children: Wheat Allergies1

Pooja Tolani and Gail P.A. Kauwell2

If your child has been diagnosed with a wheat allergy, you may be wondering what you will feed him or her, because wheat is an ingredient in so many foods. Learning about ways to manage and treat your child’s allergy can help make this diagnosis less scary. This publication is designed to provide you with information about wheat allergies and tips to help keep your child safe and reaction-free.

Figure 1. 

Wheat.


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Wheat Allergy

A wheat allergy occurs when the body treats wheat as a harmful substance and overreacts to protect itself. While wheat allergies are very common in children, most outgrow it by the time they reach the age of twelve; however, in some cases, this may not occur until children reach their teenage years (NIH 2016), and, in others, it remains throughout their life (Keet et al. 2009).

A wheat allergy is not the same as celiac disease, although these conditions are often confused with each other. Celiac disease is caused by the body’s abnormal response to a protein called gluten. Gluten is found in wheat, rye, barley, and foods made with these grains. For this reason, individuals with celiac disease or gluten intolerance must avoid eating all gluten-containing foods (i.e., foods containing wheat, rye, or barley). On the other hand, a person with a wheat allergy only needs to avoid wheat and products made with wheat.

Most allergic reactions happen after a wheat-containing food is eaten; however, it is possible that inhaling wheat, such as in the form of flour, can cause a reaction (Kidhealth.org 2016). A reaction also may occur if your child accidentally eats products such as makeup, bath items, and children’s modeling clay because some of these products contain wheat. It is best to avoid non-edible products that contain wheat to make sure that your child does not ingest them by accident (American College of Allergy, Asthma, and Immunology 2016).

Symptoms

The symptoms of a wheat allergy range from minor to severe. Since every child is unique, symptoms of an allergic reaction vary and may be different every time a reaction occurs. Symptoms of an allergic reaction to wheat may include:

  • sneezing,

  • stuffy or runny nose,

  • headaches,

  • nausea,

  • stomach cramps,

  • indigestion,

  • vomiting,

  • diarrhea,

  • asthma,

  • hives (itchy, red bumps on the skin), or

  • skin rash (Pietzak 2012).

A more serious reaction that sometimes occurs is anaphylaxis (pronounced an-uh-fuh-lak-sis). Anaphylaxis is a severe reaction that can affect different parts of the body and can even cause death. Symptoms of anaphylaxis include

  • wheezing or trouble breathing;

  • decreased blood pressure (may result in pale skin, weak pulse, confusion, and loss of consciousness);

  • dizziness;

  • swelling of lips, tongue, and/or throat;

  • tightness or closure of the throat; or

  • fainting (Pietzak 2012).

The following document provides examples of phrases that a child might use to describe what they are experiencing during an allergic reaction: http://www.foodallergy.org/file/child-reaction.pdf.

Anaphylaxis and other symptoms may occur within minutes or hours after being exposed to wheat (Pietzak 2012). If your child’s doctor has given you a medication to treat a reaction, keep it handy at all times, along with any directions you received. Your child may be prescribed a medication called epinephrine (pronounced eh-pi-nef-rin), which usually comes in the form of an auto-injector (Kidshealth.org 2016). Examples of products that allow you to automatically inject epinephrine include EpiPen®, EpiPen Jr®, and Adrenaclick®. If an epinephrine auto-injector is recommended by your child’s doctor, it should be used as soon as you think your child is having an allergic reaction. The epinephrine should be injected into the middle of the outer thigh or upper leg and can be done through clothing. When using an epinephrine auto-injector on a child, make sure to hold his or her leg still before and during the injection process. Your doctor can show you how and when to use this device. Immediately after using the epinephrine auto-injector, take your child to the emergency room. Being prepared and knowing when to take action will keep your child safe from the harmful effects of an allergic reaction (EpiPen® 2016).

Figure 2. 

A doctor examining a child.


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Managing a Wheat Allergy

Learning how to identify and avoid wheat-containing products makes it easier to manage wheat allergies. Safety measures should be taken to make sure your child stays away from all wheat products. If you are preparing foods that contain wheat, make sure to keep them separate from your child’s meals. If other members within your household prepare and eat wheat-containing products, they should be careful to avoid cross-contact. Cross-contact can occur in many ways, but a common example is using a knife to spread peanut butter on wheat bread and then dipping the same knife back into the jar to get more peanut butter. Because the knife came in contact with the wheat bread and was then put back into the jar, it is possible that enough wheat protein was transferred to the peanut butter to cause a reaction in someone with a wheat allergy if he or she eats peanut butter from that jar.

Creating a system to make sure food is handled safely in your home can help to prevent any accidental allergic reactions. For example, a separate food storage area (i.e., cabinets) can be assigned for your child. Placing all wheat-free food products in a certain part of the refrigerator or freezer might also be helpful (Collins 2016). In addition, the kitchen area and equipment should be cleaned thoroughly after contact with wheat products. Surfaces should be cleaned with a spray or a wipe that contains a detergent. Utensils, pots, and pans can either be washed in your dishwasher or can be cleaned by hand with the use of a clean sponge and hot, soapy water. If you are using a towel to dry your kitchen tools, make sure that it is clean. Proper handwashing is also essential for preventing accidental allergic reactions, especially if your hands were in contact with wheat. Hands should be washed with warm or hot water, scrubbed for at least 20 seconds with soap, and rinsed under clean water (Perry et al. 2004).

At the Grocery Store

Figure 3. 

A woman shopping in a grocery store.


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Finding the right food products for a child with a wheat allergy may seem like a difficult task. The Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004 was designed to help shoppers find allergen-containing foods. There are two ways that wheat-containing foods can be labeled. The label may say “Contains Wheat” (Label A) or the ingredient that contains wheat can be listed followed by the word “wheat” (Label B) (FDA 2016a).

Label A

Ingredients: Sugar, unbleached enriched flour (wheat flour, niacin, reduced iron, thiamin mononitrate, folic acid) hydrogenated soybean oil, soy flour, cornstarch, molasses, malted barley flour, salt

Contains: Wheat

Label B

Ingredients: Enriched flour (wheat flour, malted barley, niacin, reduced iron, thiamin mononitrate, riboflavin, folic acid), sugar, partially hydrogenated soybean oil, and/or cottonseed oil, high fructose corn syrup.

Except for meat, poultry, and certain egg products, FALCPA labeling rules apply to all packaged foods that are sold in the United States, including products that have been produced within the country or brought from another. Because meat, poultry, and certain egg products do not have to follow the FALCPA labeling rules but may contain wheat, it is important to be able to recognize sources of wheat in these products. An example of a meat product that may contain flour is sausage. Many sausage products use wheat flour as a binder or bread crumbs as part of the filling. Some manufacturers include allergen statements on certain meat, poultry, and egg products, but it is not a requirement (FDA 2006). So even though most food packages will have a statement to show that a product contains wheat, it is good to be aware of ingredients that are forms of wheat but go by other names (Foodallergy.org 2016) (see Table 1). You also may notice that some food labels will have statements like “may contain wheat” or “produced in a facility that also uses wheat” displayed on a package. Foods with these warnings should be avoided (Foodallergy.org 2016).

Wheat also can be found in foods that you do not suspect. Even though most of these foods should have a label stating that it contains wheat, it is useful to have an idea of which foods may need to be avoided. Examples of foods that sometimes contain wheat are included in Table 2.

There are many different types of flours that can be used as replacements for wheat flour. The following link has a list of wheat-free flours that you can purchase at the grocery store: http://www.eatright.org/~/media/eatrightimages/posters/flours/flour_11x17.ashx. As with all other food items, purchase pre-packaged flours rather than the ones from bulk bins to avoid the risk of cross-contact. Check this website for a food glossary to help you with wheat-free shopping: http://www.kidswithfoodallergies.org/media/Wheat-Allergy-Avoidance-List-Hidden-Names.pdf. See Table 3 for a list of foods that are generally safe to purchase for people with a wheat allergy.

Maintaining a Balanced Diet with a Wheat Allergy

Wheat contains nutrients like iron, B vitamins (thiamin, riboflavin, niacin, folic acid/folate, and vitamin B6), fiber, protein, and other vitamins and minerals. Children with a wheat allergy can get most of their iron from certain animal foods, such as beef, chicken, pork, and salmon. Plant sources of iron include dark green vegetables, beans (e.g., kidney, pinto, and black beans), lentils, and pumpkin seeds (Eatright.org 2016). Grains such as corn, quinoa, rice, oats, rye, buckwheat, and amaranth can be used instead of wheat. They are available in whole or flour forms (Kidshealth.org 2016). The nutritional value of these grains varies. Table 4 contains a list of non-wheat whole grains and some of the nutrients they provide (Eatright.org 2016).

To ensure that your child is following a healthy diet, it is recommended that you make half of the grains he or she eats whole grains. To find out if a food product is made with whole grains, search for the word “whole” on the package (USDA 2016).

Breakfast cereals are often a favorite among children. Look for wheat-free options made with oats, corn, or rice.

Management in School/Daycare and Babysitting

When it is time to send your child to school or daycare or leave him or her with a babysitter or other caregiver, it is important to be sure that the caregiver has the information needed to keep your child safe. Be sure to give him or her a list of items that your child needs to avoid, as well as those that are safe to consume; instructions on medication use and managing a reaction; and a list of signs and symptoms that would help the caregiver recognize allergic episodes. Providing the caregiver with a written action plan to use in the case of an emergency is also a good idea. In addition to informing caregivers, you should work with your child in helping him or her understand the nature of their wheat allergy. Once your child is aware of the condition, he or she should have a basic idea of which foods to avoid. It also might be a good idea to educate your child ahead of time with certain concepts such as knowing where to go if he or she has a question about something, what to do if a reaction is occurring, and making sure he or she knows not to swap their lunch with a peer’s lunch. This link provides specific guidelines on managing your child’s food allergies when they are in a school setting: http://www.foodallergy.org/file/school-parent-guide.pdf.

Dining Out

If you are dining away from home with your child, make sure that those in charge of food preparation, such as restaurant staff, are aware of the wheat allergy and its serious side effects. The best way to stay safe is to order simple dishes that do not contain too many ingredients. Avoiding buffets may be a good idea since there is a high risk for cross-contact. You can also call the restaurant before going there to see if they are able to make wheat-free options or make special preparations to prevent accidental cross-contact (FDA 2016a).

Figure 4. 

A woman and a child eating at a picnic table.


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Summary

The key to treating your child’s wheat allergy is to keep him or her away from wheat. Recognizing the symptoms of an allergic reaction, reading labels, identifying wheat-containing products, and having an allergy action plan can help to prevent an accidental reaction. In your home, ensure that all members of the household properly wash their hands, practice handling food safely, and clean cookware and utensils thoroughly to prevent cross-contact. Those who care for your child should be notified and provided with instructions on how to manage a wheat allergy. You can keep your child safe from an allergic reaction by following these guidelines, staying educated, and maintaining a relationship with your child’s doctor, school nurse, and others involved in helping your child cope with their wheat allergy.

References

American College of Allergy, Asthma, & Immunology. 2016. "Wheat Allergy." Available at: http://acaai.org/allergies/types/food-allergies/types-food-allergy/wheat-gluten-allergy. Accessed May 26, 2017.

Collins, S. 2016. “Practice Paper of the Academy of Nutrition and Dietetics: Role of the Registered Dietitian Nutritionist in the Diagnosis and Management of Food Allergies.” Journal of the Academy of Nutrition and Dietetics. 116(10):1621–1631. doi:10.1016/j.jand.2016.07.018.

Eatright.org. 2016. "Foods to Fight Iron Deficiency." Available at: http://www.eatright.org/resource/health/wellness/preventing-illness/iron-deficiency. Accessed January 5, 2017.

EpiPen® (epinephrine) and EpiPen Jr® (epinephrine) Auto-Injectors. 2016. "How to Use Your EpiPen." Available at: https://www.epipen.com/about-epipen/how-to-use-epipen. Accessed May 26, 2017.

Foodallergy.org. 2016. "Wheat—Food Allergy Research and Education." Available at: http://www.foodallergy.org/allergens/wheat-allergy. Accessed May 26, 2017.

Food and Drug Administration (FDA). 2006. "Guidance for Industry: Questions and Answers Regarding Food Allergens, including the Food Allergen Labeling and Consumer Protection Act of 2004 (Edition 4)." Available at: https://www.fda.gov/food/guidanceregulation/guidancedocumentsregulatoryinformation/allergens/ucm059116.htm. Accessed June 3, 2017.

Food and Drug Administration (FDA). 2016a. "Food Allergen Labeling And Consumer Protection Act of 2004." Available at:http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm106890.htm. Accessed January 5, 2017.

Food and Drug Administration (FDA). 2016b. "Starches—Common or Usual Names." Available at: http://www.fda.gov/ICECI/ComplianceManuals/CompliancePolicyGuidanceManual/ucm074605. Accessed May 26, 2017.

Keet, C., E. Matsui, G. Dhillon, P. Lenehan, M. Paterakis, and R. Wood. 2009. “The natural history of wheat allergy.” Annals of Allergy, Asthma & Immunology. 102(5):410–415. doi:10.1016/s1081-1206(10)60513-3.

Kidshealth.org. 2016. "Wheat Allergy." Available at: https://kidshealth.org/en/parents/wheat-allergy.html?WT.ac=ctg. Accessed May 26, 2017.

NIH: National Institute of Allergy and Infectious Diseases. 2016. "Food Allergies." Available at: https://www.niaid.nih.gov/diseases-conditions/food-allergy. Accessed May 26, 2017.

Perry, T., M. Conover-Walker, A. Pomés, M. Chapman, and R. Wood. 2004. “Distribution of peanut allergen in the environment.” Journal of Allergy and Clinical Immunology. 113(5):973–976. doi:10.1016/j.jaci.2004.02.035.

Pietzak, M. 2012. “Celiac Disease, Wheat Allergy, and Gluten Sensitivity: When Gluten Free Is Not a Fad.” Journal of Parenteral and Enteral Nutrition. 36(1 Suppl):68S–75S. doi:10.1177/0148607111426276.

US Department of Agriculture (USDA). 2016. “All about the Grains Group.” Choose MyPlate. Available at: https://www.choosemyplate.gov/grains. Accessed January 5, 2017.

The Whole Grains Council. 2016. "Compare Nutrients in Various Grains." Available at: http://wholegrainscouncil.org/whole-grains-101/what-are-health-benefits/compare-nutrients-various-grains. Accessed January 5, 2017.

Tables

Table 1. 

Sources of wheat that go by other names:

Bread crumbs

Einkorn

Pasta

Wheat***

Bulgar

Emmer

Seitan

Wheat bran hydrolysate

Cereal extract

Farina

Semolina

Wheat germ oil

Club wheat

Flour*

Spelt

 

Couscous

Hydrolyzed wheat protein

Sprouted wheat

Wheat protein isolate

Cracker meal

Kamut®

Triticale

Whole wheat berries

Durum

Matzoh, matzoh meal**

Vital wheat gluten

 

*All purpose, bread, cake, durum, enriched, graham, high gluten, high protein, instant, pastry, self-rising, soft wheat, steel ground, stone ground, whole wheat

**Other spellings: matzo, matzah, or matza

*** Followed by these terms: bran, durum, germ, gluten, grass, malt, sprouts, starch

Source: Foodallergy.org (2016)

Table 2. 

Foods that sometimes contain wheat:

Glucose syrup

Marinara sauce

Processed meats

Gelitanized starch*

Surimi

Potato chips

Sauces

Modified starch*

Soy sauce

Rice cakes

Caramel color

Vegetable starch*

Ice cream

Ready-to-eat breakfast cereals

Soups

Food starch*

* If “starch” is listed as an ingredient itself it usually means cornstarch, unless the package states that it is from a different source (FDA 2016b)

Source: (Foodallergy.org 2016)

Table 3. 

Foods that are generally SAFE to purchase for people with a wheat allergy:

Plain frozen, fresh, or canned fruits and vegetables

Quinoa

Nuts*

Plain dairy products (e.g., milk, yogurt, and cheese)

Rye

Beans

Plain eggs

Tapioca

Peas

Rice

Barley

Lentils

Corn

Buckwheat

Plain tofu

*Avoid coated or flavored nuts.

Table 4. 

Nutrients provided by selected non-wheat whole grains*

Grain

Nutrients (based on approximately 1 cup cooked)

Quinoa

Good source of: protein, fiber, iron, copper, thiamin, vitamin B6. Excellent source of: magnesium, phosphorus, manganese, folate.

Cornmeal

Good source of: fiber, magnesium, phosphorus, manganese, selenium, thiamin.

Brown Rice

Good source of: magnesium, phosphorus, selenium, thiamin, niacin, vitamin B6. Excellent source of: manganese.

Rolled Oats

Good source of: protein, fiber, iron, magnesium, phosphorus, zinc, copper, selenium, thiamin. Excellent source of: manganese.

Rye

Good source of: magnesium, phosphorus, copper, selenium. Excellent source of: fiber, manganese.

Amaranth

Good source of: protein, fiber, iron, copper, selenium, vitamin B6. Excellent source of: magnesium, phosphorus, manganese.

Buckwheat

Good source of: protein, fiber, phosphorus, riboflavin, niacin. Excellent source of: magnesium, copper, manganese.

*Source: (The Whole Grains Council 2016)

Footnotes

1.

This document is FSHN17-4, one of a series of the Food Science and Human Nutrition Department, UF/IFAS Extension. Original publication date June 2017. Visit the EDIS website at http://edis.ifas.ufl.edu.

2.

Pooja Tolani, dietetic intern; and Gail P.A. Kauwell, professor, Food Science and Human Nutrition Department; UF/IFAS Extension, Gainesville, FL 32611.


The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information and other services only to individuals and institutions that function with non-discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, marital status, national origin, political opinions or affiliations. For more information on obtaining other UF/IFAS Extension publications, contact your county's UF/IFAS Extension office.

U.S. Department of Agriculture, UF/IFAS Extension Service, University of Florida, IFAS, Florida A & M University Cooperative Extension Program, and Boards of County Commissioners Cooperating. Nick T. Place, dean for UF/IFAS Extension.