Parents of children with wheat allergy reveal gaps in knowledge, confidence
Key takeaways:
- Parents may not know when common foods include wheat.
- 89.7% of families practiced food restrictions.
- About half of respondents were not confident that they would know when or how to use an autoinjector.
SAN DIEGO — When children have a wheat allergy, it can significantly affect the quality of life of their parents, but education and support may mitigate these impacts, according to an abstract presented here.
“Wheat allergies are common around the world,” Nam Sze Cheng, RN, DN, nurse, department of pediatrics, the Chinese University of Hong Kong, said during her presentation at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.
Parents generally are told to keep foods that include wheat such as bread or cookies away from their children, Cheng said, but wheat can be difficult to avoid. For example, she said, French fries are coated in flour to make them crispy, and wheat is added to soy sauce for fermentation.
“Another issue that worries parents is the scary experience of their children getting anaphylaxis after accidentally ingesting wheat products,” she said. “This causes parents to panic when introducing new food to their children.”
Cheng and her colleagues explored the relationship between adverse reactions, quality of life and parental knowledge and competence in managing their children’s wheat allergies.
“We also wanted to identify some common misunderstandings or difficulties,” she added.
The study included 29 children (mean age, 5.85 years; 15 boys) with wheat allergy recruited from the Prince of Wales Hospital Allergy clinic between September 2023 and August 2024.
Researchers conducted detailed participant histories of wheat allergy and other atopic diseases in addition to taking blood to measure wheat-specific IgE, Cheng said. Children also participated in skin prick testing and double-blind, placebo-controlled oral food challenges for wheat.
Parents included 23 fathers (79.3%) and 20 mothers (69%) who attended university. Also, 28 of the children (96.6%) were breastfed.
“Most of the recruited families were well educated and ready to spend time and energy on their children,” Cheng said.
Also, 86.2% of the children had eczema, 48.3% had allergic rhinitis, 79.3% had more than one food allergy, 27.6% required hospitalization due to a food allergy and 89.7% practiced food restrictions. Symptoms included angioedema (51.7%), shortness of breath or wheeze (20.7%) and widespread hives (51.7%).
Specifically, reactions to wheat developed within 15 minutes for 37.9% of the children, 72.4% had not experienced an episode in the previous 2 months due to avoidance, and symptoms ranged from 2 hours to a full day for 37.9%.
“We can see that 69% of them failed the oral food challenge, which means they have a true, confirmed wheat allergy,” Cheng said.
When parents completed the 20-item Food Allergy Knowledge Questionnaire, 14.3% correctly identified how to introduce new foods to infants with food allergy, 20% correctly identified the signs of an allergic reaction and 17.1% correctly identified products that include food ingredients that could cause an allergic reaction.
On the 10-item Confidence in Food Allergy Management Skills questionnaire, 54.3% of parents said they were not too confident or less that they knew when to use an epinephrine autoinjector, and 57.2% said they were not too confident or less that they knew how to use an epinephrine autoinjector.
“Parents are not being adequately educated on how to use this lifesaving medication,” Cheng said.
Further, parents completed the Parental Quality of Life questionnaire, with a varied number of items based on the age of the child, and the 17-item Food Allergy Quality of Life – Parental Burden questionnaire.
These questionnaires indicated that when parents have more knowledge about food allergy and confidence in managing them, their quality of life and their competence in dealing with adverse reactions both improve, Cheng said.
Quality of life for parents also is worse when children with wheat allergy are younger, she said, as well as when children have both wheat allergy and eczema. But parents of children who have multiple food allergies had higher quality of life scores.
“This may be because they have more experience in dealing with food allergy adverse reactions, or they have sought more information about food allergies,” Cheng said. “Practice makes perfect, and education is very important.”
Responses also indicated five frequently asked questions that parents have:
- Are there any side effects when children who are not experiencing anaphylaxis receive epinephrine?
- When children need an autoinjector, where should the injection go?
- What are the criteria for determining whether a child needs a pediatric or an adult dose of epinephrine for anaphylaxis?
- Can parents use an expired autoinjector when a child is experiencing anaphylaxis?
- What should you do when someone is experiencing a severe allergic reaction, but they do not have an autoinjector?
The incorrect responses on the knowledge questionnaire and these frequently asked questions indicate opportunities for tailored education for parents of children with wheat allergy, Cheng said.
“Most importantly, we can demonstrate how to use the adrenaline autoinjector and ask them to show us back to confirm that injection technique,” Cheng said.
Cheng also recommended prescribing oral immunotherapy for children with a confirmed wheat allergy.
“Parents of children with wheat allergy must have appropriate food allergy knowledge and management skills, and their confidence should be built through the practice of using an adrenaline autoinjector and support from health care providers and their families,” Cheng concluded.
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