Wheat allergy in babies (and how it differs from celiac disease)

Three different things

Parents often hear “wheat allergy”, “gluten allergy”, “celiac” and “gluten intolerance” used as if they meant the same thing. They don’t, and the difference matters for what you do next.

Wheat allergy is a food allergy. The immune system overreacts to proteins in wheat, usually within minutes to 2 hours of eating it. It can cause hives, vomiting or a runny nose, and rarely anaphylaxis (ACAAI, NHS). It’s most common in children, and many outgrow it.

Celiac disease (spelled coeliac in the UK) is an autoimmune condition. The immune system reacts to gluten, a protein in wheat, barley and rye, and damages the lining of the small intestine, so the body can’t take in nutrients properly. Symptoms build up over time rather than minutes: diarrhea, tummy pain, bloating, and in children, not growing as expected (NHS). It’s lifelong, and the treatment is a strict gluten-free diet. See celiac disease and starting gluten.

Food intolerance is difficulty digesting a food. It isn’t caused by the immune system overreacting, so it can’t cause a serious allergic reaction. Symptoms such as diarrhea, bloating, gas and tummy pain usually come a few hours after eating (NHS).

ACAAI points out that “gluten allergy” is a misleading term: there’s a wheat allergy, and there’s celiac disease, but no such thing as a gluten allergy. It also notes that there’s no accurate test for gluten intolerance.

At a glance

• Wheat allergy: reaction to wheat protein. Fast, usually within 2 hours. Hives, swelling, vomiting, rarely anaphylaxis. Tested by an allergist (skin prick or blood IgE test). Avoid wheat until your allergist says otherwise, and ask them about barley, rye and other grains.
• Celiac disease: reaction to gluten (wheat, barley, rye). Builds up over time. Diarrhea, bloating, poor growth. Tested with a different blood test, while still eating gluten. Lifelong gluten-free diet.
• Intolerance: trouble digesting a food. Hours after eating. Bloating, gas, diarrhea. A doctor or dietitian may suggest a few weeks without the food, then bringing it back to see if symptoms return (NHS). Don’t try this with gluten on your own: celiac disease can only be diagnosed while your child is eating gluten (ACAAI). Home intolerance tests aren’t recommended (NHS).

Introducing wheat

Wheat can be introduced from around 6 months, like other foods. The NHS lists foods containing gluten, including wheat, barley and rye, among the foods to introduce one at a time from around 6 months, and to keep in your baby’s usual diet once they’re tolerated. The CDC lists wheat among the potentially allergenic foods to introduce when you introduce other foods.

Good first wheat foods, in safe forms:

• pasta, cooked until soft
• bread, lightly toasted and cut into strips
• couscous, stirred into a mash
• wheat-based infant cereal, mixed with breast milk or formula

Avoid whole wheat kernels, plain wheat germ, and breads or crackers with seeds, nut pieces or whole grain kernels: the CDC lists these as choking hazards. If whole grains are part of a dish, the CDC says to cook and finely grind or mash them.

Offer the first wheat food on a day your baby is well, at home, when you can watch them for a couple of hours afterward. Start with a small amount, then keep wheat in your baby’s diet: see keeping allergens in the diet.

Don’t hold wheat back to try to prevent celiac disease. Trials show that starting gluten later doesn’t lower the risk (see celiac disease and starting gluten).

Signs of wheat allergy

Reactions usually start within minutes of eating, but can take up to 2 hours (NHS).

Mild to moderate (ACAAI, NHS):

• hives or a skin rash
• vomiting once, tummy pain or diarrhea
• a stuffy or runny nose, or sneezing

If it’s only one of these, stop offering wheat, stay with your baby and watch them closely for the next couple of hours, and call your pediatrician before you try it again. If signs show up in more than one part of the body at once, treat it as anaphylaxis (below).

Signs of anaphylaxis are trouble breathing, wheezing or a cough that won’t stop, swelling of the tongue or throat, lips or mouth that suddenly swell, a hoarse cry, turning pale or floppy, becoming very sleepy or unresponsive, or signs in more than one part of the body at once. If you see any of these and your baby has an epinephrine (adrenaline) auto-injector, use it right away, then call for an ambulance. Call 911.Call 999.Call your local emergency number (such as 112 in Europe or 000 in Australia). If you don’t have an auto-injector, call straight away. Keep your baby lying down, never standing or walking (on their side if they’re vomiting, head and shoulders a little raised if breathing is hard), and go to hospital even if they seem better. See signs of anaphylaxis.

Slower gut symptoms that build up over time, like diarrhea that lasts, a swollen tummy or poor weight gain, can have other causes, including celiac disease. Talk to your pediatrician, GP or health visitor, and keep gluten in your baby’s diet until they’ve been checked: ACAAI says celiac disease can only be diagnosed while a child is eating gluten.

How it’s diagnosed

Some symptoms of wheat allergy, celiac disease and gluten sensitivity overlap, so ACAAI says an accurate diagnosis is crucial.

• For wheat allergy, an allergist may do a skin prick test or a blood test for IgE to wheat. If the results aren’t clear, they may suggest an oral food challenge in their office, with emergency medicine on hand.
• For celiac disease, a different blood test is used to screen, and the diagnosis is made by a gut specialist (gastroenterologist) while your child is still eating gluten (ACAAI).

Don’t cut wheat out on your own. The NHS says not to cut foods out of a child’s diet without the advice of a GP or dietitian, because your child could miss out on nutrients they need for growth.

If your baby has a wheat allergy

• Read labels. In the US, wheat is one of the 9 major allergens that must be named on packaged foods, for example “flour (wheat)” (FDA). Wheat turns up in cereals, pasta, crackers, and even some hot dogs, sauces and ice cream (ACAAI).
• Check non-food items too. ACAAI notes that modeling dough and some cosmetics and bath products contain wheat, and food labeling rules don’t cover them.
• “May contain” labels are voluntary in the US, and ACAAI says people with wheat allergy should also avoid products with them. Ask your allergist what applies to your child.
• “Gluten-free” isn’t the whole story. Gluten-free foods should be wheat-free, but they also leave out barley and rye, which some children with wheat allergy can eat. ACAAI says that isn’t true for everyone, so ask your allergist about each grain. ACAAI says not to rely on a “free from” label in place of reading the full ingredients.
• Swap in other grains. ASCIA suggests rice, corn, quinoa, buckwheat and millet. ACAAI says many people with wheat allergy can eat other grains, but not everyone, so ask your allergist which are safe. See rice, quinoa, millet and buckwheat, and check labels for wheat in grain mixes.
• See a dietitian. ASCIA says babies with wheat allergy should see an allergy dietitian, to support their diet and growth.
• Keep introducing the other allergens. ASCIA says a baby allergic to one food should still have the others.

Wheat allergy is often outgrown: ACAAI says about 65% of children with wheat allergy outgrow it by age 12. Your allergist will tell you if and when to test again.

Where US and UK advice differs

• The spelling. Celiac in the US, coeliac in the UK.
• How labels group it. US labels name wheat as one of 9 major allergens (FDA). UK labels list “cereals containing gluten”, including wheat, rye, barley and oats, as one of 14 allergens, emphasized in the ingredients list, for example in bold (GOV.UK).
• Who should check first. The NHS asks you to talk to your GP or health visitor before introducing allergens if your baby has eczema or a food allergy, or there’s a family history of food allergies, eczema, asthma or hay fever. US guidance singles out severe eczema and egg or other food allergy.