Gluten Sensitivity Rash: Recognizing Its Appearance and Impact on Individuals
In the realm of food allergies, a less common but equally important type is the non-IgE-mediated wheat allergy. Unlike its IgE-mediated counterpart, this allergy presents with distinct symptoms and immune mechanisms.
Symptoms and Onset
The symptoms of a non-IgE-mediated wheat allergy primarily involve gastrointestinal issues such as repetitive vomiting, diarrhea, abdominal pain, and nausea. These reactions typically occur several hours (1-4 hours) after wheat ingestion, a marked difference from IgE-mediated allergies which usually cause immediate symptoms. Some cases may also involve extreme lethargy and failure to thrive, particularly in children with conditions like food protein-induced enterocolitis syndrome (FPIES), food protein-induced enteropathy (FPE), or allergic proctocolitis (FPIAP), types of non-IgE-mediated gastrointestinal food allergies.
Immune Mechanism and Triggers
Unlike IgE-mediated allergies, non-IgE reactions generally do not cause immediate urticaria, angioedema, or anaphylaxis. Instead, they result from T-cell mediated immune responses to wheat proteins such as gliadin and other components. This T-cell involvement causes the delayed hypersensitivity reactions seen in non-IgE-mediated allergy.
Diagnosis and Management
An allergist can help diagnose a wheat allergy through various tests, including skin tests, challenge tests, or blood tests. In the case of hives, an allergist may ask the individual to keep a food diary to help eliminate food groups to which a person may be allergic. If hives are severe, a corticosteroid medication such as prednisone may be recommended to help ease symptoms.
The most common medications available for hives are antihistamines, and a person can also use a cold compress or anti-itch balm to help relieve symptoms. In the case of anaphylaxis, an epinephrine pen should be used followed by dialing 911 or the number of the nearest emergency department.
IgE-Mediated Wheat Allergies
An IgE-mediated wheat allergy can cause symptoms such as hives, itching, tingling or itchy mouth, runny nose, swollen face and lips, abdominal pain, and in severe cases, anaphylaxis. Wheat is one of the more common culprits of food-dependent exercise-induced anaphylaxis (FDEIA). An allergist may prescribe an epinephrine (Epi) injection for any suspected IgE-mediated food allergy, even if hive reactions in the past have not been associated with lips, tongue, or face swelling.
Prevalence and Risk Factors
Approximately 65% of children with a wheat allergy have outgrown it by the age of 12. A history of eczema is the most important risk factor for developing a food allergy. It's also worth noting that delayed-type nonallergic autoimmune response, specifically due to gluten, includes celiac disease - dermatitis herpetiformis, which may cause a rash to develop 48-72 hours after ingestion of wheat.
Common Wheat-Containing Foods to Avoid
Some of the food types that can trigger a wheat allergy rash include bread, bulgar wheat, couscous, durum wheat, freekeh, hydrolyzed wheat protein, malt, modified wheat starch, pasta, rusk, semolina, wheat bran, wheat flour, wheat germ, and whole wheat.
In conclusion, understanding the differences between IgE-mediated and non-IgE-mediated wheat allergies is crucial for proper diagnosis and management. If you suspect you or your child may have a wheat allergy, it's essential to consult with an allergist for accurate diagnosis and guidance.
- Non-IgE-mediated wheat allergies, unlike their IgE-mediated counterparts, present with distinct symptoms like repetitive vomiting, diarrhea, abdominal pain, and nausea.
- These reactions typically occur several hours after wheat ingestion, often varying between 1-4 hours.
- An allergic proctocolitis (FPIAP) is a type of non-IgE-mediated gastrointestinal food allergy that may be associated with extreme lethargy and failure to thrive.
- Unlike IgE-mediated allergies, non-IgE reactions generally do not cause immediate urticaria, angioedema, or anaphylaxis.
- T-cell mediated immune responses to wheat proteins such as gliadin cause the delayed hypersensitivity reactions seen in non-IgE-mediated allergy.
- An allergist can help diagnose a wheat allergy through various tests, including skin tests, challenge tests, or blood tests.
- In the case of hives, an allergist may ask the individual to keep a food diary to help eliminate food groups to which a person may be allergic.
- Antihistamines are the most common medications available for hives, and a person can also use a cold compress or anti-itch balm to help relieve symptoms.
- In the case of anaphylaxis, an epinephrine pen should be used followed by dialing 911 or the number of the nearest emergency department.
- An IgE-mediated wheat allergy can cause symptoms such as hives, itching, tingling or itchy mouth, runny nose, swollen face and lips, and in severe cases, anaphylaxis.
- Approximately 65% of children with a wheat allergy have outgrown it by the age of 12.
- A history of eczema is the most important risk factor for developing a food allergy.
- Celiac disease – dermatitis herpetiformis, a delayed-type nonallergic autoimmune response specifically due to gluten, may cause a rash to develop 48-72 hours after ingestion of wheat.
- Some of the food types that can trigger a wheat allergy rash include bread, bulgar wheat, couscous, and pasta.
- Understanding the differences between IgE-mediated and non-IgE-mediated wheat allergies is crucial for proper diagnosis and management.
- If you suspect you or your child may have a wheat allergy, it's essential to consult with an allergist for accurate diagnosis and guidance.
