The wheat ladder

What is the wheat ladder?

The wheat ladder is a way to reintroduce wheat into the diet of children who are growing out of a wheat allergy. You have been advised by your doctor or dietitian that it is safe to start introductions at home.

The ladder starts with small amounts of wheat, and increase in steps to larger amounts, until your child is able to tolerate age-appropriate portions of wheat-containing foods. At this latter stage, your child is no longer considered to have an allergy to wheat and can eat it regularly as part of their usual diet.

When should I start the wheat ladder?

You can start the wheat ladder when your child is completely well and does not have any coughs or colds. Any eczema, hay fever, rhinitis or asthma they may have must be well controlled.

Choose a day when you have time to observe your child for at least two hours after they have eaten the food. If they have an emergency allergy treatment plan, then please ensure you have their emergency treatment with you.

What to do if a reaction occurs at any step

If your child has any signs of an immediate allergic reaction (for example hives, swelling, onset of cough, wheezing, sneezing, itchy eyes, abdominal pain, vomiting or diarrhoea) stop the reintroduction. If they have an allergy treatment plan please give their medication as advised.

• Contact your GP if your child seems unwell.
• Contact your paediatrician, allergy team or dietitian if you need further advice.
• If your child has symptoms of a delayed allergic reaction a few hours or up to three days after eating wheat (e.g. vomiting, diarrhoea, eczema flare) then stop the reintroduction and allow your child to recover.
• You may be able to continue to include smaller amounts of wheat in your child’s diet if they were tolerating this previously.

The wheat ladder

Please note: you may need to start with smaller amounts of wheat, or move more slowly through the introductions depending on your child’s history and type of wheat allergy. Your doctor or dietitian will discuss this with you if this is the case.

Choose one of the following foods in the full portion size suggested:

• 1 - 2 Weetabix
• 1 slice bread or toast
• 2 digestive biscuits
• 2 Rich Tea biscuits
• 50g cooked pasta

You can then introduce this food into your child’s diet by following the steps below. Please use the same food throughout the reintroduction.

If your child can manage an age-appropriate portion of the food chosen for seven days, without any symptoms of allergy, then they can include wheat freely in their diet.

• Step 1 - ½ teaspoon of the chosen food, for 3 days
• Step 2 - 1 teaspoon of food, for 3 days
• Step 3 - 2 teaspoons of food for 3 days
• Step 4 - ¼ portion of food for 3 days
• Step 5 - ½ portion of food for 3 days
• Step 6 - Give a full portion of food every day for 7 days

Contact

Dietitian: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Telephone: 01223 216655