Symptoms of wheat allergy vary widely and can be described according to the NICE food allergy guidelines. [1]
Classically, IgE mediated wheat allergy shows symptoms of rashes, urticaria (hives), angioedema, wheeze and anaphylaxis (table 1).
Non-IgE mediated/mixed IgE and non-IgE mediated wheat allergy shows symptoms of diarrhoea, constipation, delayed type eczema, vomiting (and reflux and in some (very rare cases) blood in stools or FPIES (table 1).
| 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 |
| • Diarrhoea | • 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 | |
Reference
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.