Barley allergy
Allergy to barley.
About barley allergy
Barley is a cereal grain that contains gluten, and it is used in bread, soups, stews and, importantly, in malt and brewing. There are two quite different problems it can cause. One is a true IgE-mediated allergy to barley proteins, which is what this page mainly concerns; the other is coeliac disease, an autoimmune condition triggered by gluten that is not an allergy. Cereal grains, including barley, are among the allergens that must be declared on UK food labels.
In IgE-mediated barley allergy, symptoms usually begin within minutes to two hours of eating and can include an itchy mouth, hives, swelling, wheezing and stomach upset. In some people, barley and other cereals can be involved in wheat-dependent exercise-induced anaphylaxis, where a severe reaction occurs only when eating the grain is followed by exercise. Because barley, wheat, rye and oats are related grains, some people react to more than one, though this is not universal.
Diagnosis involves a specialist assessment with skin-prick or specific-IgE blood tests, and sometimes a supervised food challenge; coeliac disease is checked for separately with its own blood tests and, where needed, a biopsy. Management means avoiding barley and reading labels for malt, malt extract, malt vinegar and barley in drinks. People at risk of severe reactions may be prescribed an adrenaline auto-injector. Treat any severe reaction with breathing difficulty or collapse as an emergency and call 999.
Common triggers
- Barley and products containing it
Symptoms
- Itching or tingling in the mouth
- Hives, itching or eczema
- Swelling of the lips, face, tongue or throat
- Stomach cramps, nausea, vomiting or diarrhoea
- Wheezing or trouble breathing
- In severe cases, anaphylaxis
Avoidance & management
- Read ingredient labels every time
- Ask about ingredients and cross-contamination when eating out
- Keep the food out of shared cooking areas
- Carry prescribed antihistamines or an adrenaline auto-injector
- Seek emergency help for any severe reaction
Sources & references
Allergy safety: what everyone should know
Mild-to-moderate reaction signs
- Itching, hives or a raised rash
- Swelling of lips, face or eyes
- Tingling mouth, sneezing, runny nose
- Stomach pain, nausea or vomiting
Anaphylaxis — call 999 (UK) or 112 (EU) immediately
- Difficult or noisy breathing, wheeze, persistent cough
- Swelling of the tongue or tightness in the throat
- Dizziness, collapse, pale and floppy (young children)
- Use an adrenaline auto-injector (e.g. EpiPen) at once if prescribed, then call an ambulance even if symptoms improve
Allergy or intolerance? A true allergy involves the immune system and can escalate quickly; an intolerance (e.g. lactose intolerance) is unpleasant but not life-threatening. The symptoms overlap, so self-diagnosis is unreliable.
Getting tested: home-testing kits based on IgG are not diagnostically valid. If you suspect an allergy, ask a GP for referral to an allergy clinic for skin-prick or specific-IgE testing and a supervised food challenge where appropriate.