Dr. Schär Institute

Wheat may cross-react with grass pollen, rye and barley and the clincal relevance of this is poorly understood. Studies looking into the cross-reactivity between wheat, rye and barley, found a clinical cross-reactivity of around 25% - 55%. Therefore, even though these clinical cross-reactions do not always exists, it clearly is a problem for some [1,2]. Therefore in some cases of wheat allergy, patients may be advised to avoid rye and barley in addition to wheat.
 
Wheat can be cross-contaminated with other grains during manufacturing but the clinical relevance of this for both IgE and non-IgE mediated wheat allergy (apart from coeliac disease) is not clear. Avoiding foods that state “may contain traces of wheat” is another highly debated point in food allergy. Having to avoid all products containing warnings of “may contain” may have a financial impact and also affect quality of life. The decision on whether to adopt a more restrictive approach such as this will be based on factors including:

• Severity of past reactions
• Amount of wheat reacted to in the past
• Co-existing asthma
• Severity of other food allergy

Level or degree of wheat avoidance required for non-IgE mediated diseases (FPIES) or those showing a mixed pattern of mechanisms (eczema and EoE) are even less clear and an individual approach based on each case is usually recommended.
 

Labelling

Those avoiding wheat should be able to read food labels and understand labelling laws, which vary across the globe. In the EU the food labelling law [3] for pre-packed foods requires that all pre-packed food, including alcoholic drinks, sold in the UK or the rest of the EU clearly list all ingredients, including any of the major allergens, including wheat, even if only present in small amounts.

In terms of wheat, according to the EU legislation the following has to be clearly identified on the label:

Cereals containing gluten namely wheat (such as spelt and Khorasan wheat), rye, barley, oats and their hybridised strains and products thereof, except:

• wheat based glucose syrups including dextrose
• wheat based maltodextrins
• glucose syrups based on barley
• cereals used for making alcoholic distillates including ethyl alcohol of agricultural origin

However, the EU directive does not abolish the use of precautionary allergen statements such as ‘may contain’ statements on labels to indicate the unintentional presence of an allergen. Thus, even though an allergen (such as wheat) is not deliberately included in the food, the manufacturer cannot guarantee that allergen is absent due to risk of cross contamination from the manufacturing process or from it being handled on site. The Food Standards Agency advises that precautionary allergen statements should only be used following a thorough risk assessment and if it is considered that there is a real risk to the consumer.

At the end of 2014 [3], new legislation from the EU came into force, which requires food businesses to provide allergy information on food sold, unpackaged, in for example restaurants, catering businesses, deli’s, bakeries and sandwich bars. The Food Standards Agency has produced guidance to help businesses with this [4].
 

Advice regarding wheat avoidance

A referral to a registered dietitian is crucial to ensure that the diet remains balanced and healthy while avoiding wheat in appropriate levels.