Treatment

Complete elimination of wheat from the diet is the only available therapy to treat IgE-mediated WA. In allergy associated with wheat ingestion, patients should follow an adequate wheat elimination diet and be trained in the correct interpretation of product labels [168]. To prevent WDEIA, patients must avoid wheat consumption in any circumstance, but if not, they can only exercise 6 h after the consumption of wheat or wheat-containing

products [170]. In the case of baker's asthma, a total restriction of exposure to wheat flours is recommended [168].

However, in many cases, strict avoidance of wheat is challenging because wheat is present in so many distinct food products, and involuntary exposure to small traces can occur. Currently, new approaches to treat IgE-mediated WA are actively being sought. Immunotherapy is a promising treatment based on the administration of increasing amounts of an allergenic source to regulate the immune system and achieve remission of allergic symptoms [182]. Three distinct types of immunotherapy are currently being tested: sublingual immunotherapy (SLIT), oral immunotherapy (OIT), and epicutaneous immunotherapy (EPIT). In SLIT and OIT the amount of food ingested is gradually increased to avoid the induction of systemic reactions, while EPIT involves delivering the allergen to the patient using a skin patch [183].

#### 3.3.2. Non-IgE-Mediated Wheat Allergy

Non-IgE-mediated wheat allergy usually occurs 2 h after ingestion of wheat. It is strongly associated with eosinophilic esophagitis (EoE) or eosinophilic gastritis (EG), which occur when eosinophils infiltrate the gastrointestinal tract [168]. Typical manifestations of this type of WA are indigestion, diarrhea, vomiting, arthralgia, and headaches that can appear numerous hours or days after consumption of allergens [11].
