WHEAT AND GRAIN ALLERGY
Perhaps the most difficult foods to eliminate from your diet are the grains and the flours made from them. Most people eat bread, pasta, baked goods, breakfast cereals, and many snack foods, daily. Just think of your usual routine: for breakfast, cereal, toast, pancakes, or perhaps a toaster pastry; a mid-morning snack that may be a muffin or Danish pastry; for lunch, a sandwich made with bread, perhaps with a bowl of noodle soup; a cookie at mid-afternoon “to keep up your energy” until supper, which may consist of lasagna, spaghetti, or some other pasta dish, or possibly pizza whose crust is, of course, bread. And then before bed, perhaps another cookie. It is difficult to imagine a day without products made from flours and grains.
When you suspect that you may be reacting to wheat or another staple grain, or perhaps have been to the allergist and have been told that your skin or blood test for wheat or other grains is positive, you are going to have to eliminate grains and flours from your diet, at least for a short time. The task at first seems almost impossible especially if you have a hectic lifestyle and rely heavily on convenience foods that need little preparation. It is hard indeed to find prepared foods that do not contain grains and flours. But don’t despair, this chapter is designed to help you through this process.
The first thing we need to do is discuss why grains can cause allergies and how you can best avoid the ones that cause problems. Understanding which part of the grain needs to be avoided will help you have a clearer idea of what to substitute for it. And this is what we want to achieve-not to deprive you of grains and baked goods entirely, but to give you the information that will help you to find acceptable substitutes. This will be especially important if you discover, after the process of elimination and reintroduction, that you are going to have to continue to avoid perhaps wheat and its related grains for the long-term.
Composition of Grains
Although the carbohydrate content of grains is much higher than their protein content, it is the protein that causes the immune system response in an allergic reaction. Wheat is the grain most commonly reported to cause allergic reactions; it is also the grain most common in the Western diet. Allergy to other grains (e.g., oats, rye, barley, corn, rice) is experienced less frequently.
Proteins in Wheat
Protein makes up about 12% of the dry wheat kernel. There are four classes of wheat proteins:
Gliadins
Glutenins
Albumins
Globulins
Gliadins and glutenins form the gluten complex. Gliadins contain as many as 40 to 60 distinct components; glutenins contain at least 15. The molecular size of the protein components in wheat is 10 to 40 kilodaltons, the size considered optimal for triggering a Type I hypersensitivity reaction. Other cereal grains contain similar mixtures of proteins which theoretically could trigger a hypersensitivity reaction.
Allergy to Wheat Proteins
No single protein or class of proteins seems to be responsible for wheat allergy. People who are allergic to wheat tend to react to the albumins and globulins, rather than to the gliadins and glutenins. However, some researchers disagree with this generalization and believe there is more evidence for immune responses to gliadins and globulins than to albumins and glutenins. Interestingly, despite this demonstrable immune reactivity (IgE positivity in RAST [radio-aller-go sorbent test] in most cases), some people show no clinical evidence of wheat allergy when they consume wheat. On the other hand, many people with demonstrable symptoms after consuming wheat are RAST-negative. These findings simply emphasize the importance of elimination and challenge in identifying of a sensitivity to wheat or any other grain before it is excluded from a person’s diet for a prolonged period of time.
The most common symptoms of wheat allergy are asthma (in asthmatics), rhinitis, and conjunctivitis, resulting from flour or grain dust in work environments.
Grains and Celiac Disease
Individuals with gluten-sensitive enteropathy (celiac disease, also called sprue) react to the alpha-gliadin component of gluten. Although researchers have proposed a variety of mechanisms involving immune reactions as the primary trigger of celiac disease, there is no definitive evidence that it is due to an allergy.
Symptoms of celiac disease are diarrhea, weight loss, malabsorption (especially of fat), signs of iron or folate deficiency, sometimes rickets, and indications of other vitamin and mineral deficiencies. Occasionally the condition is accompanied by an itchy rash (dermatitis herpetiformis).
Celiac disease is most definitively diagnosed by a jejunal biopsy (removal and examination of tissues from a specific area of the small intestine) that reveals villous atrophy (flattened, short, or absent villi) and other abnormal changes of the lining of the jejunum. A number of blood tests are available for detecting the presence of a variety of specific antibodies whose presence is indicative of celiac disease. A suspicion that celiac disease is the cause of a person’s symptoms should always be confirmed by laboratory data so that treatment is not undertaken inappropriately. Treatment is lifelong and consists of the strict avoidance of all grains that contain gluten, namely, wheat, rye, oats, and barley. However, it is important to realize that not all wheat intolerance, grain intolerance, or even gluten intolerance is due to celiac disease.
Symptoms of Wheat Allergy
Wheat has been reported to be the provoking allergen in a number of different allergic conditions. Abdominal pain and loose stools beginning within 12 to 72 hours after eating wheat are the most frequently reported symptoms of wheat allergy. In children this pattern often accompanies an allergy to cow’s milk proteins.
Ingested and inhaled wheat flour has been demonstrated to cause asthma in both adults and children and is one of numerous food and environmental allergens implicated in causing eczema. Wheat allergy also may provoke hives and angioedema (tissue swelling, especially of the face). An anaphylactic reaction to wheat has been reported in young infants, but is a very rare occurrence. Exercise-induced anaphylaxis after eating wheat has been reported several times.
Allergy to Other Cereal Grains
The incidence of allergy to other cereal grains and the degree of cross-reactivity among cereal grains is unknown. Allergy to oats, rye, or barley is uncommon, and therefore restricting these grains is rarely necessary except for the treatment of celiac disease. Corn allergy is rare but has been documented in a number of reports, mainly in children. Allergy to rice appears to be equally uncommon. If allergy to any grain is suspected, elimination and challenge should be carried out to confirm the suspicion and determine the specific grain causing the adverse reaction.
Allergy to cereal grains other than wheat is discussed later.
The Wheat-Free Diet
In Western countries, it is difficult to avoid wheat because wheat is a principal ingredient in many commonly eaten foods. Breads, breakfast cereals, crackers, cookies, muffins, pasta, snack foods, luncheon meats, sausages, candies, desserts, cakes, pies, pancakes, waffles, and many other wheat-containing products are the basis of the “convenience foods” associated with the fast-paced Western lifestyle. These products supply the nutrients occurring naturally in wheat, as well as those added in the fortification of wheat flour, namely, thiamin, riboflavin, niacin, and iron. However, they can be obtained from other sources, so a wheat-free diet need not result in the loss of any important nutrients.
Important Nutrients in Wheat
Wheat and wheat products are a significant source of thiamin, riboflavin, niacin, iron, selenium, chromium, and in smaller amounts, magnesium, folate, phophorous, and molybdenum. Many of these micronutrients are added to wheat cereals and flours as fortifiers. Alternative choices of foods to replace these include oats, rice, rye, barley, corn, buckwheat, amatanth, and quinoa, some of which are fortified with micronutrients similar to those found in wheat products. Flours that are suitable as replacements for wheat flour include flours and starches from rice, potato, rye, oats, barley, buckwheat, tapioca, millet, corn, quinoa, and amaranth.
Spelt, kamut, triticale, and flours derived from these grains are too closely related to wheat to be considered safe on a wheat-free diet, unless specifically demonstrated to be tolerated by elimination and challenge.
If you can tolerate rye, oats, barley, corn, and rice, then you can consume baked products, cereals, and pastas using these grains instead of those using wheat. In addition, unusual grains and flours such as millet, quinoa, amaranth, buckwheat, tapioca, sago, arrowroot, soy, lentil, pea, and bean, as well as nuts and seeds, may be used in interesting combinations to make baked products and cereals.
Label-Reading Guidelines for a Wheat-Free Diet
When restricting any food from the diet, you need to become familiar with terms that may appear on product labels indicating that the food is present. Wheat may appear in food products under the terms listed in Table Food products that contain wheat. Hydrolysed plant protein (HPP), hydrolysed vegetable protein (HVP), and monosodium glutamate (Monosodium glutamate) may be made from wheat. However, because the hydrolysis process breaks down the protein to a form that is unlikely to be allergenic, avoiding these products is not considered necessary.
Table Food products that contain wheat
| Terms That Indicate the Presence of Wheat | ||
| Bread crumbs | Cracked wheat | Semolina |
| Bran | Cracker meal | Spelt |
| Bulgur | Durum | Triticale |
| Gluten | Durum flour | Kamut |
| High-gluten flour | Enriched flour | Couscous |
| Vital gluten | Self-rising flour | Anything with “wheat” in the
name, for example: |
| Protein flour | Pastry flour | |
| High-protein flour | Bread flour | -Wheat berries |
| Graham flour | Unbleached flour | -Wheat germ |
| Graham crackers | All-purpose flour | -Wheat bran |
| Crackers | Phosphated flour | -Wheat starch |
| Matzoh | White bread | -Sprouted wheat |
| Cereal extract | Sourdough bread | -Wheatena |
| Fanina | Multigrain flour | -Wheat gluten |
| Flour | Multigrain bread | -Whole-wheat bread and flour |
| Seitan | -60% wheat bread | |
Products That May Contain Wheat
(unless source is declared to be other than wheat)
| Gelatinized starch | Vegetable starch Soy sauce |
| Hydrolyzed vegetable protein (HVP) | Malt |
| Hydrolyzed plant protein (HPP) | Grain coffee substitute |
| Malt | Postum |
| Starch (unless origin is specified, e.g., “corn starch”) | Granola |
| Modified starch (unless origin is specified) | Granola bar |
| Vegetable gum |
Wheat-Free Diet
The wheat-free diet on the next four pages omits wheat and foods containing wheat products. (Table The wheat-free diet: foods allowed and foods restricted ). This diet is not suitable for the treatment of celiac disease because it is not gluten-free.
Table The wheat-free diet: foods allowed and foods restricted
| Type of Food | Foods Allowed | Foods Restricted |
| Milk and
Milk Products |
• Milk (whole milk; 2%; 1%;
skim; lactose-reduced (Lactaid, Lacteeze): acidophilus) • Cream • Sour cream • Buttermilk • Yogurt • Cheese of all types • Cottage cheese • Ricotta • Feta • Quark • Any other food made from pure milk |
• Any milk product containing
wheat (usually as a thickener), such as - Instant cocoa - Hot chocolate mixes - Malted milk - Oval tine - Coffee substitutes (e.g., Postum) • Cheese sauces, spreads, and other dairy foods containing wheat |
| Grains,
Cereals, Flours, and Starches Grains, Cereals, Flours, and Starches (continued) |
Grains, cereals, flours, and
starches made with or derived from • Amaranth • Arrowroot • Barley • Buckwheat • Corn • Kasha • Lentil or pea flour • Nut meal and flour (all types) •Oats • Quinoa • Rice (all types) • Rye • Sago • Seed meal and flour • Soy flour • Tapioca Breads and baked goods: Any made from allowed flours and starches such as • Rice bread • Rice and soy bread • Rye bread • Cornmeal bread made without wheat flour • Breads, muffins, cookies, pancakes, waffles, and cakes made with allowed grains Crackers and snacks Any made from allowed grains such as • Corn chips • Corn nachos • Corn taco chips • Potato chips • Rice cakes, plain, with seeds or with other allowed grains • Rice crackers Breakfast cereals Any made from any grain on allowed list, e.g., oats, barley, rye, millet, and corn, such as • Oatmeal • Corn flakes • Cream of Rice • Rice Krispies • Puffed rice • Puffed millet • Kenmei Rice Bran • Puffed amaranth |
Grains, cereals, flours, and
starches made with or derived from • Bulgur • Couscous • Cracked wheat • Durum • Farina • “Gluten enriched” flour • Graham • Kamut • Malt • Matzoh • Semolina • Spelt • Starch • Triticale • Wheat • Wheaten • Wheat bran and germ • Wheat berries Breads and baked goods: Any item made from restricted flours or starches • Any regular white or whole- wheat bread, buns, croissants, or bagels • Cakes, muffins, pancakes, cookies, waffles, etc., made with wheat or white flour • Bread crumbs • Cracker meal Crackers and snacks Any containing wheat, such as • Graham crackers • Cheese crackers • Ritz™ crackers • Saltines™ • Champagne™ crackers • Vegetable Thins™ • Matzoh Breakfast cereals Any breakfast cereal containing wheat, such as • Shredded wheat • Puffed wheat • Weetabix ‘ Wheaties ‘ Wheatena • Cream of Wheat • Red River Cereal ‘ Miniwheats • Others (read labels carefully) |
| Pasta | Pasta made from any grain
on allowed list, such as • Soy pasta • Buckwheat pasta • Mung bean pasta • Bean vermicelli • Rice noodles and pasta • Brown rice pasta • Wild rice pasta • Corn pasta • Potato pasta • Quinoa pasta |
Any pasta made with wheat flour
including • Spinach • Carrot • Egg noodles • Vermicelli • Others (read labels carefully) |
| Vegetables | • All prepared with allowed
ingredients • All vegetable juices • All pure fresh, frozen, or canned vegetables |
• Vegetables prepared with a
dressing or garnish containing wheat • Salad dressings containing wheat (starch) as a thickener • Sprouted wheat |
| Fruit | • All pure fruits and fruit juices | • Commercial pie fillings
• All fruit dishes containing wheat • Fruit pies with a crust made from wheat flour • Fruit pies with Graham cracker crust |
| Meat, Poultry,
and Fish |
• All plain, fresh, frozen, or
canned meat, poultry, or fish • Those prepared without wheat, wheat batters, or bread crumbs |
Meat dishes that may contain
wheat, such as • Battered • Breaded • Croquettes • Luncheon meats • Meat loaves • Meat balls • Patties • Pate • Sausages • Spreads • Stuffing • Weiners • Processed meats |
| Eggs | • All eggs and egg dishes
prepared without wheat |
• Egg dishes containing wheat
• Scotch eggs (wheat is in the sausage) |
| Legumes | • All prepared without wheat
• Plain tofu • Peanut butter • Tamari sauce |
• Legume dishes containing wheat,
usually as a thickener • Soya sauce |
| Nuts and Seeds | • All plain seeds and nuts | • Snack nuts and seeds with HVP, HPP, or Monosodium glutamate |
| Fats and Oils | • Butter
• Cream • Margarine • Shortening • All pure vegetable, nut and seed oils • Fish oils • Lard • Meat drippings • Peanut and other pure nut and seed butters • Homemade gravy thickened with nonwheat starch (e.g., corn, tapioca, arrowroot) • Nut and seed butters |
• Wheat germ oil
• Salad dressings containing wheat • Sauces containing wheat (usually as a thickener) • Gravy thickened with wheat flour or starch |
| Spices and Herbs | • All plain spices and herbs | • Seasoning mixes containing wheat, HVP*, HPP*, or Monosodium glutamate*, such as
- Packaged soup seasoning mixes - Bouillon cubes |
| Sweets and
Sweeteners |
• Sugar
• Honey • Molasses • Jams • Jellies • Preserves • Baking chocolate and pure cocoa powder |
All sweets containing wheat, such
as • Icing sugar* • Candy* • Marshmallows* |
‘Avoid these products unless the source is known not to be wheat.
Grain Allergy
Ideas for Substituting Grains in Selected Meals
Breakfast Foods
Cooked grains make enjoyable breakfast cereals when fruit, honey, nuts, or seeds are added.
Cook amaranth, millet, quinoa, and buckwheat grain like brown rice: Combine a cup of grain with 2 1/4 or 2 1/2 cups of water.
Bring to boil, lower heat, and simmer for 45 to 60 minutes depending on the degree of “doneness” desired.
You can cook the grains in large batches (for example, 4 cups of grain), freeze it in 1-cup quantities, can reheat it in the microwave. Cooked grain provides the basis for an instant breakfast cereal.
Soup
Commercial soups are frequently thickened with restricted grains or contain restricted noodles or pasta. Bouillon cubes may contain grains. Homemade meat, poultry, or vegetable soup stocks are safe. Meat drippings can be chilled, the fat lifted off, and the meat juices used for a soup base. They may be thickened with tapioca, arrowroot, or starch if desired.
Easy Vegetable Stock
Use any combination of washed and trimmed onion skins, potato and carrot peelings, celery strings and leaves, parsley stems, green bean and tomato ends, outer lettuce leaves. Save trimmings in a plastic bag in the fridge or freezer. Cover with water in a saucepan. Add a bay leaf and pepper and bring to a boil. Simmer for 30 minutes. Strain and add salt to taste. Use instead of consomme or soup base. Freeze leftovers in ice cube trays.
Desserts
The following desserts are allowed:
♦ All desserts and baked goods made with allowed ingredients
♦ Plain gelatin desserts
♦ Fruit ices
♦ Popsicles
♦ Ice cream made with allowed ingredients but not ice cream cones
♦ Sherbet
Breads and Baked Goods
No single flour will replace wheat flour in a recipe. The texture will be different when you use a non-wheat flour, but more importantly, any baked product that is risen as an important part of its production will not retain its risen shape as it cools unless gluten is part of its structure. Non-gluten grains will drop noticeably as they cool. You can substitute alternative grains for wheat in a combination that provides an acceptable texture to the product, but you must adjust for the dense nature of the finished product.
EXAMPLES OF ALLOWED FLOURS AND STARCHES
| Amaranth flour | Potato flour | Arrowroot starch or flour |
| Quinoa flour | Buckwheat flour | Rice flour (brown and white) |
| Channa flour | Rye flour | Chickpea flour (Besan) |
| Sago flour | Lentil flour | Soy flour |
| Millet flour (Bajri) | Tapioca starch or flour | Nut meal or flour (any type) |
| T’eff |
Substitutes for Restricted Flours in Recipes
In place of restricted flours in recipes, combinations of alternative flours make better cakes, cookies, breads, pancakes, and waffles than a single flour alone. A combination of rice, soy, potato, and arrowroot (or tapioca,) starch makes an acceptable bread mix. Use 1 cup of the mix in place of 1 cup of wheat flour in recipes.
Combining “light,” “intermediate,” and “heavy” flours in the ratio on the next page will give a better baked product than using any single flour.
| Light Flours | Intermediate Flours | Heavy Flours |
| White rice | Potato | Soy |
| Tapioca | T’eff | Buckwheat |
| Arrowroot | Brown rice | Millet |
| Sago | Amaranth | |
| Chickpea | ||
| Any nut | ||
| Quinoa |
Combine in a ratio:
| 1/2 cup heavy flour |
| 1/4 cup light flour |
| ¼ cup intermediate flour |
1 cup of the combined flours will substitute for 1 cup of any restricted flour in recipes, but some adjustments in liquid levels or cooking times may be required to obtain an equivalent texture, especially in breads.
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