Diagnosing Wheat Allergy: Guidance for Clinicians

Marrecca Fiore; Gary J. Stadtmauer, MD


March 05, 2013

Editor's Note:

Often patients who are experiencing unpleasant and possible allergy symptoms after eating certain foods will consult with their primary care providers first about their concerns. Identifying food allergies can be difficult, but wheat allergy presents a unique challenge in that it may be confused with celiac disease, an autoimmune condition triggered by the wheat protein gluten.

In this interview, Medscape Allergy & Clinical Immunology advisory board member and blogger Gary Stadtmauer, MD, provides guidance on how to differentiate between celiac disease and wheat allergy, and also offers advice on diagnosing and managing the patient with wheat allergy.

Medscape: How should a primary care provider approach a patient who describes feeling ill after eating foods such as bread, crackers, and pasta?

Dr. Stadtmauer: They should approach the patient the same way they would any other patient with suspected food hypersensitivity. They first need to make a determination as to whether this occurs each and every time the patient ingests the food. The next step is to determine the nature of the reaction: Are there hives with nasal or asthmatic symptoms that would be characteristic of an immunoglobulin E-mediated response? Or are symptoms purely gastrointestinal, which would suggest gluten sensitivity?

Medscape: Who is most likely to suffer from wheat allergy? Is there a certain age group or demographic, for example?

Dr. Stadtmauer: Infants and children are much more likely than adults to have an immediate hypersensitivity to wheat, as opposed to gluten intolerance.

Medscape: Much attention has been given to gluten and its role in adverse health conditions. Are there differences between gluten intolerance and wheat allergy, or is this the same condition with different names?

Dr. Stadtmauer: Allergists are very particular about discriminating between intolerance, which basically means "it does not agree with me," as opposed to an allergy, which involves some arm of the immune system. However, when it comes to gluten, even some clinicians confound intolerance, which is not immunologic, with true gluten sensitivity. Wheat contains a variety of gluten proteins, the most harmful of which is gliadin. The range of reactions to gluten proteins runs from subtle to chronic. Diarrhea, with the characteristic inflammatory changes, is seen with the more severe form, which is known as celiac disease. This immune-based inflammatory disease primarily affects the gastrointestinal tract and leads to malabsorption and dietary insufficiencies. There may also be a blistering rash, known as dermatitis herpetiformis, seen in celiac disease. An intermediate form of disease with chronic gastrointestinal symptoms but negative celiac testing seems to exist, and these patients also get better on a gluten-free diet.