Wheat Allergy

<p><b><a href="http://en.wikipedia.org/wiki/Wheat" title="Wheat">Wheat</a> allergy</b> is a <a href="http://en.wikipedia.org/wiki/Food_allergy" title="Food allergy">food allergy</a>, but can also be a contact allergy resulting from occupational exposure. Like all allergies wheat allergy involves <a href="http://en.wikipedia.org/wiki/IgE" title="IgE" class="mw-redirect">IgE</a> and <a href="http://en.wikipedia.org/wiki/Mast_cell" title="Mast cell">mast cell</a> response. Typically the allergy is limited to the seed storage proteins of wheat, some reactions are restricted to wheat proteins, while others can react across many varieties of seeds and other plant tissues. Wheat allergy may be a misnomer since there are many allergenic components in wheat, for example <a href="http://en.wikipedia.org/wiki/Serine_protease" title="Serine protease">serine protease</a> inhibitors, <a href="http://en.wikipedia.org/wiki/Glutelin" title="Glutelin">glutelins</a> and <a href="http://en.wikipedia.org/wiki/Prolamin" title="Prolamin">prolamins</a> and different responses are often attributed to different proteins. Twenty-seven potential wheat allergens have been successfully identified<sup id="cite_ref-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-0">[1]</a></sup>. The most severe response is exercise/aspirin induced anaphylaxis attributed to one omega gliadin that is a relative of the protein that causes <a href="http://en.wikipedia.org/wiki/Coeliac_disease" title="Coeliac disease">coeliac disease</a>.<sup id="cite_ref-pmid17655322_1-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid17655322-1">[2]</a></sup> Other more common symptoms include nausea, <a href="http://en.wikipedia.org/wiki/Urticaria" title="Urticaria">urticaria</a>, <a href="http://en.wikipedia.org/wiki/Atopy" title="Atopy">atopy</a>.<sup id="cite_ref-pmid16566866_2-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid16566866-2">[3]</a></sup>

<h2>Types of allergens</h2>

<p>There are four major classes of seed storage proteins: <a href="http://en.wikipedia.org/wiki/Albumin" title="Albumin">albumins</a>, <a href="http://en.wikipedia.org/wiki/Globulin" title="Globulin">globulins</a>, prolamins and glutelins. Within wheat, <a href="http://en.wikipedia.org/wiki/Prolamin" title="Prolamin">prolamins</a> are called <a href="http://en.wikipedia.org/wiki/Gliadin" title="Gliadin">gliadins</a> and <a href="http://en.wikipedia.org/wiki/Glutelin" title="Glutelin">glutelins</a> are called <a href="http://en.wikipedia.org/wiki/Glutenin" title="Glutenin">glutenins</a>. These two protein groups form the classic glutens. While gluten is a causative agent of <a href="http://en.wikipedia.org/wiki/Coeliac_disease" title="Coeliac disease">Coeliac disease</a> (CD), coeliac disease can be contrasted to gluten allergy by the involvement of different immune cells and antibody types (See <a href="http://en.wikipedia.org/wiki/Gluten_sensitivity#Comparative_pathophysiology" title="Gluten sensitivity">Comparative pathophysiology of gluten sensitivities</a>), and because the list of allergens extend beyond the classic gluten category of proteins.</p>

<h3>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=2" title="Edit section: Gluten allergy">edit</a>] Gluten allergy</h3>

<h4>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=3" title="Edit section: Prolamin allergies">edit</a>] Prolamin allergies</h4>

<p><a href="http://en.wikipedia.org/wiki/Prolamin" title="Prolamin">Prolamins</a> and the closely related glutelins, a recent study in Japan found that glutinins are a more frequent allergen, however gliadins are associated with the most severe disease. A proteomics based study found a γ-gliadin isoform gene.<sup id="cite_ref-pmid17655322_1-1" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid17655322-1">[2]</a></sup> Wheat dependent exercise induced anaphylaxis (WDEIA) is primarily mediated by <a href="http://en.wikipedia.org/wiki/Triticeae_glutens#Chemical_behavior" title="Triticeae glutens">ω-5 gliadin</a> which is encoded by the Gli-1B gene derived from the <a href="http://en.wikipedia.org/wiki/Triticeae#Aegilops" title="Triticeae"><i>Aegilops speltoides</i></a> B genome within wheat.</p>

<h4>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=4" title="Edit section: Glutelin allergies">edit</a>] Glutelin allergies</h4>

<p>Glutenin (wheat glutelin) is a predominant allergen in wheat.<sup id="cite_ref-pmid17655322_1-2" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid17655322-1">[2]</a></sup> Nine subunits of <a href="http://en.wikipedia.org/wiki/Triticeae_glutens#Chemical_behavior" title="Triticeae glutens">LMW-glutinen</a> have been linked in connection with wheat allergies.</p>

<h3>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=5" title="Edit section: Albumin and globulin allergy">edit</a>] Albumin and globulin allergy</h3>

<p>At present many of the allergens of wheat have not been characterized; however, the early studies found many to be in the albumin class.<sup id="cite_ref-pmid7067068_3-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid7067068-3">[4]</a></sup> A recent study in Europe confirmed the increased presence of allergies to amylase/trypsin inhibitors (serpins)<sup id="cite_ref-pmid17655322_1-3" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid17655322-1">[2]</a></sup><sup id="cite_ref-pmid8334538_4-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid8334538-4">[5]</a></sup> and lipid transfer protein (LPT).<sup id="cite_ref-pmid17496422_5-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid17496422-5">[6]</a></sup> but less reactivity to the globulin fraction<sup id="cite_ref-pmid3839248_6-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid3839248-6">[7]</a></sup> The allergies tend to differ between populations (Italian, Japanese, Danish or Swiss),<sup class="Template-Fact" >[<i><a href="http://en.wikipedia.org/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a></i>]</sup> indicating a potential genetic component to these reactivities.</p>

<h3>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=6" title="Edit section: Other allergies">edit</a>] Other allergies</h3>

<h4>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=7" title="Edit section: Wheat pollen and grass allergies">edit</a>] Wheat pollen and grass allergies</h4>

<p>Respiratory allergies are an occupational disease that develop in food service workers. Previous studies detected 40 allergens from wheat; some cross-reacted with rye proteins and a few cross-reacted with grass pollens.<sup id="cite_ref-pmid65335_7-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid65335-7">[8]</a></sup> A later study showed that baker's allergy extend over a broad range of cereal grasses (wheat, durum wheat, triticale, cereal rye, barley, rye grass, oats, canary grass, rice, maize, sorghum and Johnson grass) though the greatest similarities were seen between wheat and rye <sup id="cite_ref-pmid6154431_8-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid6154431-8">[9]</a></sup> and that these allergies show cross reactivity between seed proteins and pollen proteins<sup id="cite_ref-pmid3228051_9-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid3228051-9">[10]</a></sup> including a prominent crossreactivity between the common environment rye pollen and wheat gluten<sup id="cite_ref-pmid2253081_10-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid2253081-10">[11]</a></sup><sup id="cite_ref-pmid15783130_11-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid15783130-11">[12]</a></sup></p>

<h4>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=8" title="Edit section: Derivative allergies">edit</a>] Derivative allergies</h4>

<p><a href="http://en.wikipedia.org/wiki/Protein" title="Protein">Proteins</a> are made of a chain of dehydrated amino acids. When enzymes cut proteins into pieces they add water back to the site at which they cut, called enzymatic hydrolysis, for proteins it is called proteolysis. The initial products of this <a href="http://en.wikipedia.org/wiki/Hydrolysis" title="Hydrolysis">hydrolysis</a> are polypeptides, and smaller products are called simply peptides; these are called <i>wheat protein hydrolysates</i>. These hydrolysates can create allergens out of wheat proteins that previously did not exist by the exposure of buried antigenic sites in the proteins.

When proteins are cut into polypeptides, buried regions are exposed to the surface, and these buried regions may possibly be antigenic. Such hydrolyzed wheat protein is used as an additive in foods and <a href="http://en.wikipedia.org/wiki/Cosmetics" title="Cosmetics">cosmetics</a>. The peptides are often 1 kD in size (9 amino acid residues in length) and may increase the allergic response.<sup id="cite_ref-pmid16534217_12-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid16534217-12">[13]</a></sup> These wheat polypeptides can cause immediate contact urticaria in susceptible people.<sup id="cite_ref-pmid16689814_13-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid16689814-13">[14]</a></sup></p>

<h2>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=9" title="Edit section: Signs and Symptoms">edit</a>] Signs and Symptoms</h2>

<p>Wheat allergies are not altogether different from other food allergies or respiratory allergies. However two conditions, <a href="http://en.wikipedia.org/wiki/Exercise-induced_anaphylaxis" title="Exercise-induced anaphylaxis">exercise/aspirin induced anaphylaxis</a> and <a href="http://en.wikipedia.org/wiki/Urticaria" title="Urticaria">urticaria</a> occur more frequently with wheat allergies.

Common symptoms of a wheat allergy include <a href="http://en.wikipedia.org/wiki/Eczema" title="Eczema">eczema</a> (<a href="http://en.wikipedia.org/wiki/Atopic_dermatitis" title="Atopic dermatitis">atopic dermatitis</a>), <a href="http://en.wikipedia.org/wiki/Urticaria" title="Urticaria">hives (urticaria)</a>, <a href="http://en.wikipedia.org/wiki/Asthma" title="Asthma">asthma</a>, <a href="http://en.wikipedia.org/wiki/Hay_fever" title="Hay fever" class="mw-redirect">"Hay fever" (allergic rhinitis)</a>, <a href="http://en.wikipedia.org/wiki/Angioedema" title="Angioedema">angioedema</a> (tissue swelling due to fluid leakage from blood vessels), abdominal cramps, <a href="http://en.wikipedia.org/wiki/Nausea" title="Nausea">nausea</a>, and <a href="http://en.wikipedia.org/wiki/Vomiting" title="Vomiting">vomiting</a>.<sup id="cite_ref-Wheat_Allergy_ASSA_14-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-Wheat_Allergy_ASSA-14">[15]</a></sup> Rarer symptoms include<sup class="Template-Fact" >[<i><a href="http://en.wikipedia.org/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a></i>]</sup> <a href="http://en.wikipedia.org/wiki/Anaphylaxis" title="Anaphylaxis">anaphylactic shock</a>, <a href="http://en.wikipedia.org/wiki/Arthritis" title="Arthritis">arthritis</a>, bloated stomach, chest pains, depression or mood swings, <a href="http://en.wikipedia.org/wiki/Diarrhea" title="Diarrhea">diarrhea</a>, dizziness, <a href="http://en.wikipedia.org/wiki/Headache" title="Headache">headache</a>, joint and muscle aches and pains (may be associated with progressive arthritis), <a href="http://en.wikipedia.org/wiki/Palpitation" title="Palpitation">palpitations</a>, <a href="http://en.wikipedia.org/wiki/Psoriasis" title="Psoriasis">psoriasis</a>, <a href="http://en.wikipedia.org/wiki/Irritable_bowel_syndrome" title="Irritable bowel syndrome">irritable bowel syndrome</a> (IBS), swollen throat or tongue, tiredness and lethargy, and unexplained cough. Reactions may become more severe with repeated exposure.</p>

<h3>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=10" title="Edit section: Asthma, Anaphylaxis, Nasal Allergies">edit</a>] Asthma, Anaphylaxis, Nasal Allergies</h3>

<h4>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=11" title="Edit section: Exercise-induced anaphylaxis">edit</a>] Exercise-induced anaphylaxis</h4>

<p>Wheat gliadins and potentially oat avenins are associated with another disease, known as wheat-dependent <a href="http://en.wikipedia.org/wiki/Exercise-induced_anaphylaxis" title="Exercise-induced anaphylaxis">exercise Induced Anaphylaxis</a> (WDEIA) which is similar to Baker's Allergy as both are mediated by IgE responses.<sup id="cite_ref-Bakers_EIA_compare_15-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-Bakers_EIA_compare-15">[16]</a></sup> In WDEIA, however, the ω-gliadins<sup id="cite_ref-EIA_w_gliadin_16-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-EIA_w_gliadin-16">[17]</a></sup> or a high molecular weight glutenin subunit, and similar proteins in other <i>Triticeae</i> genera enter the blood stream during exercise where they cause acute asthmatic or allergic reaction.<sup id="cite_ref-EIA_Aspirin_17-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-EIA_Aspirin-17">[18]</a></sup> One recent study of ω-gliadins demonstrated these gliadins are more similar to the bulk of oat avenins than α/β or γ gliadins but, so far, oat avenins have not been linked to WDEIA. Wheat may specifically induce WDEIA and certain chronic <a href="http://en.wikipedia.org/wiki/Urticaria" title="Urticaria">urticaria</a> because the anti-gliadin IgE detects ω<sub>5</sub>-gliadins expressed by most of the Gli-B1 alleles but almost no responses prolamins extracted from rye or wheat/rye translocates. The Gli-B1 gene in wheat, <i><a href="http://en.wikipedia.org/wiki/Triticum_aestivum" title="Triticum aestivum" class="mw-redirect">Triticum aestivum</a></i> comes from one of three progenitor species, <i><a href="http://en.wikipedia.org/wiki/Aegilops_speltoides" title="Aegilops speltoides">Aegilops speltoides</a></i>, indicating that nascent mutations on the B genome of wheat or from a small number of cultivated <a href="http://en.wikipedia.org/wiki/Triticeae" title="Triticeae">triticeae</a> species.<sup id="cite_ref-pmid17263477_18-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid17263477-18">[19]</a></sup></p>

<h4>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=12" title="Edit section: Aspirin sensitivity and wheat allergy">edit</a>] Aspirin sensitivity and wheat allergy</h4>

<p>Recent study of WDEIA shows that both aspirin and exercise increase the presence of gliadin in the blood stream<sup id="cite_ref-pmid17507204_19-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid17507204-19">[20]</a></sup> and the chronic induced behavior may extend to NSAIDs, MSG, Benzoate and other synthetic chemical food additives.</p>

<h4>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=13" title="Edit section: Baker's Allergy">edit</a>] Baker's Allergy</h4>

<p>Baker's allergy has a ω-gliadin component and thioredoxin hB component.<sup id="cite_ref-pmid16522470_20-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid16522470-20">[21]</a></sup> In addition, a gluten-extrinsic allergen has been identified as <a href="http://en.wikipedia.org/wiki/Aspergillus" title="Aspergillus">aspergillus</a> <a href="http://en.wikipedia.org/wiki/Amylase" title="Amylase">amylase</a>, added to flour to increase its baking properties.</p>

Allergic urticaria on the shin</div>

</div>

<h3>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=14" title="Edit section: Urticaria, Atopy, Eczema">edit</a>] Urticaria, Atopy, Eczema</h3>

<p>Contact Sensitivity,<sup id="cite_ref-pmid6175150_21-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid6175150-21">[22]</a></sup> Atopic Dermatitis,<sup id="cite_ref-pmid2736432_22-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid2736432-22">[23]</a></sup> Eczema, and Urticaria appear to be related phenomena the cause of which is generally believed to be the hydrophobic prolamin components of certain Triticeae, Aveneae cultivars, in wheat one of these proteins is ω-gliadin (Gli-B1 gene product). A study of mothers and infants on an allergen-free diet demonstrated that these conditions can be avoided if wheat sensitive cohort in the population avoid wheat in the first year of life.<sup id="cite_ref-pmid2754147_23-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid2754147-23">[24]</a></sup> As with exercise induced anaphylaxis aspirin (also: tartrazine, sodium benzoate, sodium glutamate (MSG), sodium metabisulfite, tyramine) may be sensitizing factors for reactivity.<sup id="cite_ref-pmid2610332_24-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid2610332-24">[25]</a></sup> Studies of the wheat-dependent exercise induced anaphylaxis demonstrate that atopy and EIA can be triggered from the ingestion of that aspirin and probably NSAIDs allow the entry of wheat proteins into the blood, where IgE reacts within allergens in the dermal tissues. Some individuals may be so sensitive that low dose aspirin therapy can increase risk for both atopy and WDEIA.

Wheat allergies were also common with contact dermatitis. A primary cause was the <a href="http://en.wikipedia.org/w/index.php?title=Donning_agent&action=edit&redlink=1" class="new" title="Donning agent (page does not exist)">donning agent</a> used for <a href="http://en.wikipedia.org/wiki/Latex" title="Latex">latex</a> gloves prior to the 1990s, however most gloves now use protein free starch as donning agents.</p>

<h3>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=15" title="Edit section: Autoimmune (Rheumatoid) arthritis">edit</a>] Autoimmune (Rheumatoid) arthritis</h3>

<p>There appears to be an association of autoimmune rheumatoid arthritis (ARA) both with GSE and gluten allergies.<sup id="cite_ref-pmid16484508_25-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid16484508-25">[26]</a></sup> ARA in GSE/CD may be secondary to tTG autoimmunity. In a recent study in Turkey, 8 of 20 ARA patients had wheat reactivities on the RAST tests. When this allergic food and all other patient specific RAST+ foods were removed half of the patients had improved ARA by serological markers. In patients with wheat allergies, rye was effectively substituted.<sup id="cite_ref-pmid16025333_26-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid16025333-26">[27]</a></sup> This may indicate that some proportion of RA in GSE/CD is due to downstream effects of allergic responses. In addition, cross-reactive anti-beef-collagen antibodies (IgG) may explain some <i><a href="http://en.wikipedia.org/wiki/Rheumatoid_arthritis" title="Rheumatoid arthritis">rheumatoid arthritis</a></i> (RA) incidences.<sup id="cite_ref-GSE_collagen_27-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-GSE_collagen-27">[28]</a></sup></p>

<h3>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=16" title="Edit section: Neuropathies">edit</a>] Neuropathies</h3>

<p><b>Migraines</b>. In the late 70s it was reported that people with <a href="http://en.wikipedia.org/wiki/Migraines" title="Migraines" class="mw-redirect">migraines</a> had reactions to food allergens, like ARA, the most common reaction was to wheat (78%), orange, eggs, tea, coffee, chocolate, milk, beef, corn, cane sugar, and yeast. When 10 foods causing the most reactions were removed migraines fell precipitously, hypertension declined.<sup id="cite_ref-pmid87628_28-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid87628-28">[29]</a></sup> Some specific instances are attributed to wheat.<sup id="cite_ref-pmid16362649_29-0" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-pmid16362649-29">[30]</a></sup>

<b>Autism</b>. Parents of children with <a href="http://en.wikipedia.org/wiki/Autism" title="Autism">autism</a> often ascribe the children's gastrointestinal symptoms to allergies to wheat and other foods. The published data on this approach are sparse, with the only double-blind study reporting negative results.<sup id="cite_ref-30" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-30">[31]</a></sup></p>

<h2>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=17" title="Edit section: Diagnosis">edit</a>] Diagnosis</h2>

<p>Diagnoses of wheat allergy may deserve special consideration. Omega-5 gliadin, the most potent wheat allergen, cannot be detected in whole wheat preparations, it must be extracted and partially digested (similar to how it degrades in the intestine) to reach full activity. Other studies show that digestion of wheat proteins to about 10 amino acids can increase the allergic response 10 fold. Certain allergy test may not be suitable to detect all wheat allergies, resulting in cryptic allergies.<sup id="cite_ref-EIA_w_gliadin_16-1" class="reference"><a href="http://en.wikipedia.org/wiki/Wheat_allergy#cite_note-EIA_w_gliadin-16">[17]</a></sup></p>

<h2>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=18" title="Edit section: Treatment">edit</a>] Treatment</h2>

<div class="rellink boilerplate seealso">See also: <a href="http://en.wikipedia.org/wiki/Gluten-free_diet" title="Gluten-free diet">Gluten-free diet</a></div>

<p>Wheat allergies differ from gluten-diet exclusion in that some types of allergens do not create species crossreactive responses, an individual may be able to consume <a href="http://en.wikipedia.org/wiki/Barley" title="Barley">barley</a> and <a href="http://en.wikipedia.org/wiki/Rye" title="Rye">rye</a> safely, although more than likely they will be allergic to other wheat such as spelt and Kamut. Wheat is often a cryptic contaminant of many foods; more obvious items are bread crumbs, <a href="http://en.wikipedia.org/wiki/Maltodextrin" title="Maltodextrin">maltodextrin</a>, <a href="http://en.wikipedia.org/wiki/Bran" title="Bran">bran</a>, cereal extract, <a href="http://en.wikipedia.org/wiki/Couscous" title="Couscous">couscous</a>, cracker meal, <a href="http://en.wikipedia.org/wiki/Enriched_flour" title="Enriched flour">enriched flour</a>, <a href="http://en.wikipedia.org/wiki/Gluten" title="Gluten">gluten</a>, high-gluten flour, high-protein flour, <a href="http://en.wikipedia.org/wiki/Wheat_gluten_%28food%29" title="Wheat gluten (food)">seitan</a>, <a href="http://en.wikipedia.org/wiki/Semolina" title="Semolina">semolina</a> wheat, vital gluten, wheat bran, wheat germ, wheat gluten, wheat malt, wheat starch or <a href="http://en.wikipedia.org/wiki/Whole_wheat_flour" title="Whole wheat flour">whole wheat flour</a>. Less obvious sources of wheat could be <a href="http://en.wikipedia.org/wiki/Gelatinized_starch" title="Gelatinized starch" class="mw-redirect">gelatinized starch</a>, <a href="http://en.wikipedia.org/wiki/Hydrolyzed_vegetable_protein" title="Hydrolyzed vegetable protein" class="mw-redirect">hydrolyzed vegetable protein</a>, modified food starch, <a href="http://en.wikipedia.org/wiki/Modified_starch" title="Modified starch">modified starch</a>, natural flavoring, <a href="http://en.wikipedia.org/wiki/Soy_sauce" title="Soy sauce">soy sauce</a>, soy bean paste, hoisin sauce, starch, <a href="http://en.wikipedia.org/wiki/Natural_gum" title="Natural gum">vegetable gum</a>, specifically <a href="http://en.wikipedia.org/wiki/Beta-glucan" title="Beta-glucan">Beta-glucan</a>, vegetable starch. People with wheat allergy who are <a href="http://en.wikipedia.org/wiki/Gluten_sensitivity" title="Gluten sensitivity">gluten sensitive</a> may also need to avoid related <a href="http://en.wikipedia.org/wiki/Cereal" title="Cereal">cereals</a>, <a href="http://en.wikipedia.org/wiki/Rye" title="Rye">rye</a> and <a href="http://en.wikipedia.org/wiki/Barley" title="Barley">barley</a>, which have similar glutinous proteins.</p>

<h3>[<a href="http://en.wikipedia.org/w/index.php?title=Wheat_allergy&action=edit&section=19" title="Edit section: Alternative cereals">edit</a>] Alternative cereals</h3>

<p><a href="http://en.wikipedia.org/wiki/Triticeae_glutens" title="Triticeae glutens">Triticeae gluten</a>-free oats (free of wheat, rye or barley) may be a useful source of cereal fiber. Some wheat allergies allow the use of rye bread as a substitute. <a href="http://en.wikipedia.org/wiki/Rice_flour" title="Rice flour">Rice flour</a> is a commonly used alternative for those allergic to wheat. Wheat-free <a href="http://en.wikipedia.org/wiki/Millet" title="Millet">millet</a> flour, <a href="http://en.wikipedia.org/wiki/Buckwheat" title="Buckwheat">buckwheat</a>, <a href="http://en.wikipedia.org/wiki/Flax_seed" title="Flax seed" class="mw-redirect">flax seed</a> meal, <a href="http://en.wikipedia.org/wiki/Corn_meal" title="Corn meal" class="mw-redirect">corn meal</a>, <a href="http://en.wikipedia.org/wiki/Quinoa" title="Quinoa">quinoa</a> flour, <a href="http://en.wikipedia.org/wiki/Chia_seed" title="Chia seed" class="mw-redirect">chia seed</a> flour, <a href="http://en.wikipedia.org/wiki/Tapioca" title="Tapioca">tapioca</a> starch or flour, and others can be used a substitutes.

<a href="http://en.wikipedia.org/wiki/Spelt" title="Spelt">Spelt</a> and <a href="http://en.wikipedia.org/wiki/Kamut" title="Kamut" class="mw-redirect">kamut</a> are grains related to <a href="http://en.wikipedia.org/wiki/Common_wheat" title="Common wheat">common wheat</a>, but are usually a suitable substitute for people with wheat allergies or that are gluten intolerant. Spelt and Kamut are not options for those with celiac disease.</p>