Symptoms of wheat allergy vary widely and can be described according the NICE food allergy guidelines [1].
Classically, IgE mediated wheat allergy shows symptoms of rashes, urticaria (hives), angioedema, wheezing and anaphylaxis. Non-IgE mediated/mixed IgE and non-IgE mediated wheat allergy shows symptoms of diarrhea, constipation, delayed type eczema, vomiting (particularly in the case of Eosinophilic Esophagitis) and reflux and in some (very rare cases) blood in stools or FPIES.
| IgE Signs and Symptoms | Non-IgE Signs and Symptoms |
|---|---|
| Usually minutes after food ingestion (But may be up to 2 hours) | Usually hours or even days after food ingestion |
| SKIN | SKIN |
| • Pruritus | • Pruritus |
| • Erythema | • Erythema |
| • Acute urticaria (localised or generalised) | • Atopic eczema |
| • Acute angioedema (most commonly of the lips, face, or around the eyes) | |
| • Acute flaring of Atopic eczema | |
| GASTROINTESTINAL | GASTROINTESTINAL |
| • Angioedema of the lips, tongue and palate | • Gastro-oesophageal reflux disease |
| • Oral pruritus | • Loose or frequent stools |
| • Nausea | • Blood and/or mucus in stools |
| • Colicky abdominal pain | • Abdominal pain |
| • Vomiting | • Infantile colic |
| • Diarrhea | • Food refusal or aversion |
| • Constipation | |
| Faltering growth plus one or more of the above gastrointestinal presentations (with or without significant atopic eczema) | |
| RESPIRATORY | RESPIRATORY |
| (usually in combination with one or more of the above signs or symptoms) | (usually in combination with one or more of the above signs or symptoms) |
| • Upper respiratory tract symptoms - nasal itching, sneezing, rhinorrhoea or congestion | • Upper respiratory tract symptoms - nasal itching, sneezing, rhinorrhoea or congestion |
| • Lower respiratory tract symptoms (cough, chest tightness, wheezing or shortness of breath) | • Lower respiratory tract symptoms (cough, chest tightness, wheezing or shortness of breath) |
| OTHER | |
| Signs or symptoms of Anaphylaxis or other systemic allergic reactions | |
References
National Institute for Health and Care Excellence. Diagnosis and assessment of food allergy in children and young people in primary care and community settings. Clinical Guideline CG116. London: 2011.