Wheat beer allergy

Very rare food allergy, predominantly of the immediate allergy type(IgE-mediated type I allergy), the symptoms of which occur within a few minutes after consumption of the beer. A true wheat beer allergy must be distinguished from the far more common histamine intolerance, which, however, does not occur specifically with wheat beer consumption, but rather concentration-dependently with all histamine-rich foods or stimulants.

Beer allergies as a whole are rare. Wheat beer allergies are even rarer. They account for about 10% of all beer allergies (Hrgovic I 2017).

Wheat beers are beers that are produced with wheat and/or wheat malt. Names for these beers are Wheat, White and White. Wheat beers are usually brewed in top fermentation. In colloquial language, the terms wheat and wheat beer are often used synonymously. Traditionally, wheat beers can also be (top-fermented) beers brewed with barley.

Wheat beer contains about 50 different proteins, including gliadin peptides, depending on the starting product (Picariello G et al. 2015. Malt appears to be a crucial allergen in non-gluten sensitized individuals, with IgE-binding proteins cross-reactive to peaches and apples. Rarer are contact urticaria and contact allergies caused by type IV sensitization.

The clinical manifestations and their severity vary from an oral allergy syndrome with swelling of the lips and tongue to generalized acute urticaria or angioedema. Wheat and barley allergy sufferers can also react to normal beer.

Prick test with the beer types in question. Prick test for the ingredients: hop, yeast, barley, wheat proteins. Confirmation by RAST diagnostics.

Histamine intolerance must be excluded. Histamine is produced by bacteria added to beer for maturing. Histamine is present in relatively low concentrations. However, these concentrations are sufficient to trigger itching in patients with atopic dermatitis.

1. Herzinger T et al (2004) Anaphylaxis to wheat beer. Ann Allergy Asthma Immunol 92: 673-674
2. Hrgovic I (2017) Wheat beer intolerance - More than just a histamine intolerance? Act Dermatol 44: 473-474
3. Picariello G et al (2015) Proteomics, peptidomics, and immunogenic potential of wheat beer. J Agric Food Chem 63:3579-3586.