www.bfr.bund.de

DOI https://doi.org/10.17590/20230202-075856

Spelt can also trigger allergies - low level of public knowledge about spelt beinga type of wheat
BfR Opinion No 001/2023 issued 13 January 2023 (assessment as of 30 November 2020)
In the case of prepacked food, the 14 most common triggers for allergies and food intoler­
ances must always be included in the list of ingredients. These triggers include gluten-rich ce­
reals such as wheat, rye, barley and oat. Spelt is also a type of wheat and must be labelled as‘wheat’ in accordance with the Food Information Implementing Regulation (LMIDV). Merely in­cluding spelt in the list of ingredients is not enough.
The German Federal Institute for Risk Assessment (BfR) has assessed the relevance of label­ling spelt as a type of wheat in the list of ingredients in terms of protecting public health. Thereis also the question of whether commercially available spelt has the same level of allergenicity
as commercially available wheat and, if so, whether consumers are aware of this fact. Sec­
ondly, there is the question of whether the public knows that spelt is a type of wheat.
The BfR has concluded that there are no meaningful clinical data published to date that would
substantiate any claim for a lower allergenic potential for spelt compared with commerciallyavailable wheat. Furthermore, spelt and common wheat share a relatively high level of corre­
spondence in terms of potentially allergenic components (protein molecules), so one may as­
sume a similar degree of allergenicity.
The BfR conducted a representative telephone survey in order to obtain data on the extent ofpublic knowledge about spelt and wheat. Only half of the respondents stated that they knew
spelt was a member of the wheat family. Compared with wheat, only roughly one in five re­spondents assumed that spelt would have a comparable level of allergenicity.
Since there have been reports in the media that spelt is allegedly less allergenic than wheat,one may therefore assume that some wheat allergy sufferers may turn to spelt products with­out first seeking medical advice. Regardless of the allergenicity of these products, individuals
wishing to avoid wheat products for other reasons should certainly be aware of the fact thatspelt is a type of wheat.
From a health risk assessment perspective and to keep the general public properly informed,
the BfR recommends including a clear indication that spelt is a type of wheat as part of appli­
cable allergy labelling regulations.

1

Subject of the assessment

In accordance with article 21(1) letter a of Regulation (EU) No 1169/2011 on the provision offood information to consumers (FICR), substances or products causing allergies or intoler­
ances must always be indicated in the list of ingredients for prepacked food, and namely “witha clear reference to the name of the substance or product as listed in Annex II”.
The enactment of the FICR has harmonised food labelling law across the EU. With Commis­
sion Delegated Regulation (EU) No 78/2014 of 22 November 2013 amending Annexes II and
III to Regulation (EU) No 1169/2011, the EU Commission corrected the originally misleading© BfR, page 1 of 18

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www.bfr.bund.dewording of annex II(1) of the FICR, clarifying that spelt is indeed a member of the wheat family.
The amendment reads as follows: “1. Cereals containing gluten, namely: wheat (such as spelt
and khorasan wheat), rye, barley, oat or their hybridised strains, and products thereof (…)”1.
On its website, the German Allergy and Asthma Association states that spelt is not a generalsubstitute for wheat, since these allergenic cereals are virtually identical.2
In light of the above, the BfR had to address the following questions:
1. Has it been scientifically proven that commercially available spelt has the same level of al­lergenicity as commercially available wheat - or is a distinction between spelt and wheat to
be tolerated or even necessary in terms of food labelling?
2. If it is scientifically proven that commercially available spelt has the same level of aller­
genicity as commercially available wheat, are consumers aware of this fact? From a scien­tific perspective, are those individuals who suffer from allergic reactions to wheat protein
the only group whose level of knowledge needs to be assessed?
3. Are consumers aware that spelt is a member of the wheat family?
2

Results

Since spelt and common wheat are both members of the Triticum genus, there is a high de­gree of homology between the proteins found in spelt and those found in common wheat.
As of this writing, the BfR is aware of no meaningful clinical data that would clearly substanti­
ate a lower level of allergenic potential in the case of spelt as opposed to common wheat (alsoknown as ‘bread wheat’). Since commercially available spelt can therefore exhibit a level of al­lergenicity similar to that of commercially available wheat, the BfR recommends including aclear indication that spelt is a type of wheat as part of applicable allergy labelling.
In November 2020, a representative consumer phone survey conducted on behalf of the BfR
demonstrated a low level of knowledge in relation to cereal classification within the general
population in Germany, also showing that only roughly one in five respondents (22%) as­
sumed that commercially available spelt exhibits a level of allergenicity comparable to that ofcommercially available wheat. In addition, of those respondents who correctly assigned spelt
to the same cereal family as wheat, only roughly a third (32%) also assumed that both types of
cereal would have the same level of allergenicity. Knowledge that spelt is a member of thewheat family is therefore not necessarily associated with the knowledge that both species of
cereal are likely to exhibit a comparable level of allergenicity.
The study in question did not distinguish between those individuals who are allergic to wheat
protein and those who are not allergic to wheat protein. Accordingly, this survey cannot be1

https://eur-lex.europa.eu/legal-content/En/TXT/PDF/?uri=CELEX:32014R0078&rid=1, accessed on 21 November 20202

https://www.daab.de/ernaehrung/nahrungsmittel-allergien/ausloeser/uebersicht/weizen/, accessed on 21 November 2020

@BfR, page 2 of 18

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www.bfr.bund.deused to derive statements about the knowledge held specifically by allergy sufferers. In light ofthis fact, it must be assumed that some wheat allergy sufferers may possibly choose to pur­chase spelt-based products as a result of reading or viewing occasional reports in the media
that spelt is allegedly less allergenic than wheat. Regardless of this fact, spelt should also be
clearly labelled as a member of the wheat family for consumers who wish to avoid wheat prod­
ucts for other reasons.
Accordingly, the BfR believes clearly stating that spelt is a type of wheat to be an importantand advisable part of applicable labelling. In consideration of the 2019 recommendation issued
by the ALS (Working Group of Food Chemistry Appraisers for the Länder and the Federal Of­
fice of Consumer Protection and Food Safety), the BfR recommends labelling spelt flour in the
future as ‘spelt flour (type of wheat)’, with the term ‘spelt flour’ possibly being replaced by themore general term ‘spelt’. Accordingly, the recommendation would therefore be ‘spelt (type of
wheat)’ or ‘spelt flour (type of wheat)’.
3
3.1

Rationale
Wheat genus (Triticum L.)

The wheat genus (Triticum L.) is a member of the grasses family (Poaceae). Species of wheat
include common wheat (Triticum aestivum L.), durum wheat (Triticum turgidum subsp. durum),
spelt (Triticum aestivum L. subsp. spelta), einkorn wheat (Triticum monococcum) and emmer
wheat (Triticum dicoccum).
Spelt (Triticum aestivum L. subsp. spelta) and common wheat (or bread wheat) (Triticum aes­
tivum L. subsp. aestivum) constitute subspecies of common wheat (Triticum aestivum L.)(Münzing, 2008).
The wheat genus is subdivided into three lineages, which relate to the degree of polyploidy3
exhibited by the respective species. The einkorn series is diploid, having two sets of chromo­
somes (T. monococcum, 2n=14, genome AA), while the emmer series is tetraploid, with four
sets (T. dicoccum, 4n=28, genome AABB), with the final, spelt series being hexaploid, with six
sets of chromosomes (6n=42, genome AABBDD). This last series includes spelt and common
wheat (Steinmüller, 2017).
It is supposed that the hexaploid forms have resulted from natural hybridisation, targeted culti­
vation and selection. European spelt and common wheat probably came about as a result of
the hybridisation of a tetraploid wheat (T. dicoccum, AABB) with a diploid wild grass (Aegilops
tauschii, DD) roughly 10,000 years ago. This brought about the integration of the DD genome,
and would explain the complexity of the wheat genome and therefore its complex protein com­position (Appels et al., 2018; Dubcovsky and Dvorak, 2007; Steinmüller, 2017; Vasil, 2007).
Accordingly, spelt and common wheat are very closely related and can be hybridised together(Steinmüller, 2017).

3

Polyploidy = inheritable increase in the number of copies of the genome@BfR, page 3 of 18

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www.bfr.bund.de

3.2

Wheat sensitivity

In the western world, roughly 0.5 percent of children and adolescents, and roughly 1 percent of
adults are affected by an immunoglobulin E (IgE)-mediated wheat food allergy (Inomata, 2009;
Sievers et al., 2020; Venter and Arshad, 2011; Zuidmeer et al., 2008). Augmentation factors
can strengthen the allergic response and are in some cases even necessary for triggering
symptoms, such as in the case of wheat-dependent exercise-induced anaphylaxis (WDEIA).
Some of the best-known augmentation factors include physical effort and the use of non-ste­roidal anti-inflammatory drugs (NSAIDs), although alcohol, fever, acute infection and allergic
complaints during the pollen season have also been described as augmentation factors (Wormet al., 2015).
IgE-mediated wheat allergy is distinct from coeliac disease, which is a T cell-mediated, chronic
inflammatory bowel condition affecting individuals with a genetic predisposition to the disease(Sievers et al., 2020). In addition, wheat protein can also cause respiratory allergies (‘Baker’s
asthma’) and skin allergies (contact urticaria) (Czaja-Bulsa and Bulsa, 2017). More recently,
there have also been reports of non-coeliac gluten/wheat sensitivity (NCGWS, Ludvigsson etal., 2013) - a condition not requiring the involvement of IgE. Most allergy specialists havequestioned NCGWS, however, as a result of an absence of clear diagnostic criteria as well asa lack of clinical validation (Reese et al., 2018). Another condition that has been associatedwith wheat protein is irritable bowel syndrome (IBS), although no clear serological markers areavailable here either, with symptoms being similar to those of NCGWS and the circumstances
still being the subject of discussion (Catassi et al., 2017).
3.2.1 Proteins contained in wheat
Conventionally, wheat proteins are subdivided into four fractions, namely water-soluble albu­
mins and salt-soluble globulins (soluble in 0.5 mol/l NaCl), plus gliadins and glutenins, withboth of these last two proteins also being glutens (Scherf et al., 2015).
The gluten concentration is 9.4 to 10.6 percent. Using a classification system based on repeti­
tive amino acid sequences, gliadins can be grouped into α-, β-, γ- and ω types. Based on theirelectrophoretic motility in the presence of an acidic pH, glutenins can be categorised into highmolecular-weight (HMW) and low-molecular-weight (LMW) types (Burkhardt et al., 2018).
Non-gluten proteins (from the albumin or globulin fractions) include lipid transfer proteins(LTPs), puroindolines, β-amylases and α-amylase trypsin inhibitors (ATIs) (Burkhardt et al.,2018).
3.2.2

Wheat allergies

The epitopes that are responsible for the allergenicity can be found in both wheat gluten pro­teins and soluble wheat proteins (non-gluten proteins) (Juhász et al., 2012). Clinical trials on
the allergenic potential of wheat have shown that wheat-specific IgE binds to both non-gluten
and gluten protein fractions. In terms of gluten proteins, IgE antibodies taken from sera from
wheat allergy sufferers may target both gliadin as well as gluten fractions (Scherf et al., 2015).
In this study, Battais et al. (2003) show that 60 percent of wheat allergy patients exhibit IgEagainst α/β-gliadins and low-molecular-weight (LMW) glutenins, 55 percent against γ-gliadins,@BfR, page 4 of 18

German Federal Institute for Risk Assessment

www.bfr.bund.de48 percent against ω-gliadins and 28 percent against high-molecular-weight glutenin subunits(HMW-GS) (Battais et al., 2003).
The allergen database maintained by the International Union of Immunological Societies (IUIS)
and the World Health Organisation is the official reference for allergen names, and publishes
the systematic nomenclature for allergenic proteins on the www.allergen.org website(Radauer, 2017).
For wheat, 28 allergens (Tri a 12 to Tri a 45) have currently been classified, which differ fromone another in relation to their sensitisation pathway, exposure and clinical manifestation (Mat­suo et al., 2015; Tordesillas et al., 2017).4
Immune responses to many of these proven allergens can also lead to cross-reactivity withother species of cereals (Baar et al., 2012; Sievers et al., 2020).

3.3

Studies on the allergenicity of spelt and wheat

Spelt is considered to be a ‘traditional’ type of cereal by some consumers5, while common
wheat (bread wheat, i.e. the subspecies Triticum aestivum subsp. aestivum) is regarded in­stead as a ‘modern’ type of cereal6. At the same time, ‘traditional’ types of cereal are consid­
ered to be more easily digested7.
Wheat-related illnesses and the potential health benefits of types of cereal considered to be‘traditional’ instead of ‘modern’ have been investigated in many studies, while also giving rise
to controversies in scientific circles (Dubois et al., 2016; Gianfrani et al., 2015; Gianfrani et al.,2012; Iacomino et al., 2016; Prandi et al., 2017; Ribeiro et al., 2016; Valerii et al., 2015).
For its part, BfR has identified the following studies, which have investigated spelt (Triticum
aestivum subsp. spelta) in comparison with bread wheat (Triticum aestivum subsp. aestivum)in relation to an IgE-mediated wheat allergy (non-systematic literature search conducted up
until 13 November 2020).
3.3.1 Oral provocation tests
During the literature search, only one study was identified in which an oral provocation test
had been conducted with spelt in comparison to wheat. In this study (Armentia, 2012), an oral
provocation test with the common wheat variety ‘Astral’ and spelt was conducted in 66 test
subjects (45 men and 21 women) recruited using a wheat allergy database and for whom
wheat-specific IgE had been detected using the Immuno CAP system (Phadia, Uppsala, Swe­den). Oral provocation with wheat was positive in 22 (33%) patients, while only 6 (27.3%) of

4 http://www.allergen.org/viewallergen.php?aid=618, accessed on 10 November 20205https://www.alnatura.de/de-de/magazin/warenkunde/warenkunde-alte-getreidesorten/, accessed on 10 November 2020

6https://www.brigitte.de/gesund/ernaehrung/gesund-essen--­weizenwampe---­gefahr-aus-der-aehre-­10160108.html, accessed on
10 November 20207https://www.sueddeutsche.de/gesundheit/mythos-des-monats-ist-urgetreide-bekoemmlicher-als-weizen-1.3141157, accessed on
10 November 2020

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www.bfr.bund.dethese 22 patients had an immune response to spelt. Overall, however, this article has signifi­
cant shortcomings. The performance of the test, including details of the quantities of extracts
used and the severity of symptoms, is not described, nor are the type of symptoms triggered.
Nor are any patient data presented. Accordingly, this severely limits the relevance of thisstudy.
3.3.2 Studies with wheat-specific IgE
A study conducted by Sievers et al. (2020) investigated the binding capacity of wheat-specificIgE sera to water- and salt-soluble protein fractions (albumins and globulins), and water-insol­uble protein fractions (gliadins and glutenins), of selected diploid, tetraploid and hexaploid cul­
tivars of the Triticum (wheat) genus.
The cultivars selected were as follows: spelt (Triticum aestivum L. subsp. spelta, variety: Ober­
kulmer Rotkorn and Franckenkorn, a wheat-spelt hybrid); einkorn wheat (Triticum monococ­
cum, variety Terzino and Tifi); emmer wheat (Triticum dicoccum, variety Osiris and Ramses);
winter durum wheat ((Triticum durum, variety Wintergold, as well as two other varieties thatwere not further specified); tritordeum (cross between durum wheat and wild barley); and win­ter common wheat (Triticum aestivum L. subsp. aestivum (bread wheat), variety Akteur). The
extracted protein components of the cultivars were separated using gel electrophoresis andwere investigated using immunoblots to test their reactivity to wheat-specific IgE in serum. To
perform the immunoblot, a pool serum was used from six wheat-sensitised children (1 to 11
years of age), in which wheat-specific IgE had been detected. As a control, IgE pool sera that
tested negative for wheat-specific IgE from five children (3 to 13 years of age) with an atopic
condition and from six children without an atopic condition (3 months to 5 years of age) wereused in the study.
In terms of the separated protein bands from albumins and globulins, there was a high level ofsimilarity between the varieties, with the exception of einkorn wheat. The IgE detection patternin the immunoblot was also characterised by a high degree of similarity between the cultivars,
again with the exception of einkorn wheat. Overall, all cultivars of the tested varieties werepositive in the immunoblot and exhibited IgE binding to a large set of protein bands. The pro­tein banding patterns achieved with gel electrophoresis for the α-/β-, γ- and ω-gliadins differed
between the varieties, as they also did for the glutenins and residual proteins. Spelt and com­
mon wheat also differed in terms of their binding patterns. Here too, however, all cultivars werepositive in the immunoblot and exhibited IgE binding to a large set of protein bands, despite
the individual protein patterns.
The authors also used an identical method to investigate other cultivars of einkorn wheat, em­
mer wheat, common wheat, spelt, oat and rye, only in terms of the water- and salt-soluble pro­tein components albumins and globulins. In this further analysis, the protein samples werealso very similar between common/bread wheat (variety Akteur, Graziro and Goldblume) andspelt (variety Bauländer Spelz, Schwabenkorn, Oberkulmer Rotkorn), and very few differenceswere discovered in the IgE binding pattern. In terms of the IgE binding pattern, rye and oat dif­fered to wheat and spelt, but also exhibited positive signals for wheat-specific IgE. It should be
noted, however, that this study only used sera with wheat-specific IgE from children (n = 6).
A study conducted by Baar et al. (2012) screened a wheat seed cDNA expression library withpooled sera from patients for whom a wheat allergy had been confirmed. A low-molecularweight glutenin subunit (LMW-GS) Glu-B3 (allergen name: Tri a 36) was identified as an IgE@BfR, page 6 of 18

German Federal Institute for Risk Assessment

www.bfr.bund.dereactive cDNA clone. Recombinant Tri a 36 was expressed in Escherichia coli and then iso­lated as a soluble protein. A RAST-based dot blot assay was then used to test IgE reactivity to
Tri a 36 (for this, pooled sera from 26 confirmed wheat allergy sufferers were utilised). Tri a 36
reacted with IgE from sera from roughly 80 percent of the wheat allergy sufferers. An aminoacid sequence comparison of homologous proteins in other cereal species revealed a se­quence identity of 76 percent for LMW-GS in rye, 64 percent for B-hordein in barley, 48 per­cent for avenin in oat, 46 percent for γ-gliadin in spelt and 40 percent for supposed prolamin inrice. The study demonstrated that IgE from sera from wheat allergy sufferers exhibited crossreactions with protein fractions from wheat, rye, barley, oat, spelt and rice.
An experimental study conducted by Pahr et al. (2012) established a cDNA library from wheat(Triticum aestivum), and compared this with serum IgE antibodies from patients with wheatinduced inhalation allergies and food allergies. The aim here was to identify new wheat aller­
gens. The recombinant proteins were produced using E. coli bacteria. The IgE reactivity of thefive wheat allergens identified using mass spectrometry methods (1-Cys-peroxiredoxin, thiore­
doxin-h-isoform, glutathion transferase, profilin and dehydrin) was analysed in RAST-based
dot blot experiments and using ELISA with patient IgE sera. The study findings demonstrated
cross-reactions from the IgE targeting the five wheat allergens to proteins of other cereal spe­
cies. Accordingly, the allergen 1-Cys-peroxiredoxin (Tri a 32) exhibited IgE cross-reactivity
with seed proteins from barley, rye, rice, maize, soy, oat and spelt. An IgE-mediated cross-re­
activity relating to the wheat allergen thioredoxin h (Tri a 25) was also demonstrated in the
study for rice, maize, sunflower and spelt (Pahr et al., 2012).
Furthermore, cross-reactions were also demonstrated for dehydrin (Tri a 35) in rice, maize,
soy, oat, rye and spelt, and for glutathione transferase in oat and spelt (Pahr et al., 2012). In
the case of wheat profilin (Tri a 12), which has been detected by means of specific IgE anti­
bodies in patients with baker’s asthma, wheat-induced food allergies and in patients with grasspollen (hay fever) allergies (Constantin et al., 2009), no cross-reactivity with spelt was found,
but was indeed discovered in the case of maize, rice, oat and rye.
For the allergenic wheat protein α-purothionin (Tri a 37), cross-reactions to homologous pro­teins in rye and barley were also identified, but not in the case of oat, soy, rice and spelt (Pahret al., 2014).
An older study dating from 2001 (Klockenbring et al., 2001) investigated the binding of IgA,
IgE, IgG1 and IgG4 to water- and salt-soluble albumins and globulins from five samples of the
Triticum (wheat) genus, using ELISA and immunoblot assays. The samples investigated weretaken from winter wheat (variety Astron), two wheat-spelt hybrids (Franckenkorn and Hubel)
and two spelt cultivars (Bauländer Spelz and Oberkulmer Rotkorn). The following discussion
focuses only on the IgE results, since an IgE test is recommended in particular as an antibody
test for diagnosing a food allergy, with experts advising against an IgG assay (Kleine-Tebbe etal., 2009; Worm and Reese, 2016).
Six sera from individuals with specific IgE against wheat flour and grass pollen (determined us­
ing RAST-analysis, age and sex not specified) were pooled. Pooled sera from six non-re­
sponders were therefore also used as a control in this study. To distinguish between confor­
mational (discontinuous) and continuous (linear) epitopes, the ELISA analysis was conductedwith native and denatured protein samples. While the degree of IgE binding to native proteins
was roughly the same in all five cultivars (only slightly less in the case of Hubel), IgE binding in@BfR, page 7 of 18

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www.bfr.bund.dethe case of the denatured proteins was, in contrast, less strong and more varied with the vari­
ous cultivars, except for common wheat, where IgE binding strength remained roughly at thesame level. On the other hand, the immunoblot with specific IgE, also conducted under dena­
tured conditions, exhibited a relatively similar binding pattern between all cultivars. In thisstudy, however, only five cultivars were investigated, together with only six sera from individu­
als with wheat-specific IgE, whose age and sex were not specified.
3.3.3 Studies on the prevalence of allergenic proteins in spelt and wheat
Ribeiro et al. (2016) investigated the gliadin concentrations and distribution of individual gliadin
fractions (ω5, ω1,2, α/β and γ) in bread wheat (Triticum aestivum L. subsp. aestivum), spelt(Triticum aestivum L. subsp. spelta) and durum wheat (Triticum turgidum subsp. durum) (Ri­beiro et al., 2016). While gliadins were detected in all wheat species analysed, the specificconcentrations varied from one species to another.
This finding has also been confirmed by the results of a more recent investigation (Geisslitz etal., 2019). Concentrations of gluten proteins (gliadins and glutenins) in spelt, durum wheat,emmer wheat and einkorn wheat were analysed in over 300 samples, which included 15 varie­
ties each of common wheat (Triticum aestivum L.), spelt, durum wheat, emmer wheat and ein­korn wheat, all grown in the same year at four sites in Germany. Total protein concentrations
were influenced both by the site location and the wheat species. At all four sites, einkorn
wheat, emmer wheat and spelt exhibited higher concentrations of protein and glutens thancommon wheat. The gliadin proportion of gluten was higher in spelt than in common wheat,
while the glutenin concentration was roughly the same in both cases.
A quantitative mass spectrometry analysis of amylase trypsin inhibitor (ATI) concentrations
showed that the spelt and emmer wheat cultivars investigated exhibited higher concentrationsof ATI than the durum and common wheat cultivars (Geisslitz et al., 2018).
3.3.4 Proteomics study
A study conducted by Afzal et al. (2020) had the aim of analysing potential differences in theproteome of spelt and bread wheat using mass spectrometry (nano LC-ESI-MS/MS), compar­
ing proteome variation between and within these subspecies, and characterising potential en­
vironmental influences on protein expression. To this end, 15 representative varieties from cur­rent spelt and bread wheat production in Germany were used, which had been cultivated atthree separate test sites. Roughly two thirds of the proteins detected were expressed both inspelt and bread wheat (Afzal et al., 2020).
3.4

Questions

Question 1: Has it been scientifically proven that commercially available spelt has thesame level of allergenicity as commercially available wheat - or is a distinction between
spelt and wheat to be tolerated or even necessary in terms of food labelling?
Overall, the studies looking at wheat-specific IgE show that individuals with a sensitisation towheat exhibit an IgE response to both common wheat proteins and spelt proteins (Baar et al.,2012; Klockenbring et al., 2001; Pahr et al., 2012; Pahr et al., 2013; Sievers et al., 2020).
When comparing spelt and common wheat, the IgE binding patterns on the separated protein@BfR, page 8 of 18

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www.bfr.bund.defractions of the albumin/globulin fraction were very similar (Sievers et al., 2020). Accordingly,
one may assume that spelt contains allergens similar to those of common wheat in terms ofwater- and salt-soluble albumins and globulins. However, differences were observed in the IgE
binding pattern for gliadins and glutenins (Sievers et al., 2020). This means that, in terms ofthis protein fraction, spelt and common wheat can presumably also express different allergens,
to which individuals may also respond (react) differently. However, these data cannot be used
to conclude that spelt exhibits a lower allergenic potential. Furthermore, a monosensitisation toindividual wheat proteins is less common in the case of an IgE-mediated wheat allergy(Sander et al., 2011; Sievers et al., 2016). While detection of wheat-specific IgE does provide
evidence of sensitisation, this does not necessarily correlate to a clinical response in the indi­vidual. On the other hand, IgEs are a precondition for the development of allergic symptoms(Sievers et al., 2016; Sievers et al., 2020).
Data are unclear as regards the effect on allergenicity resulting from the processing of the ce­real, the site location and cultivation conditions, together with differences in protein expression
between individual cultivars within a subspecies (Geisslitz et al., 2020; Geisslitz et al., 2019;
Sievers et al., 2020; Verhoeckx et al., 2015).
The allergenic potential of any one food can be graded in terms of the severity of the allergic
reactions triggered, the threshold value for triggering an allergic reaction and the allergy’s fre­quency of occurrence (Richter et al., 2008). Since there has been a lack of systematic investi­
gations to date in the form of double-blind, placebo-controlled oral food provocation tests, theallergenic potential of spelt cannot be reliably estimated. To date, the BfR is aware of only one
case study, and furthermore one only published as a conference article abstract (German Al­
lergy Congress, Dresden, 27 to 29 September 2018)8, which has demonstrated spelt tolerance
in a child suffering from a wheat allergy. Evidence for this tolerance was secured by means ofan open food provocation test using spelt under medical supervision. The authors also note,however, that experience shows the likelihood of a cross-reaction with spelt to be very high inthe case of wheat allergy sufferers.
The rationale for this cross-reactivity is based on the close phylogenetic relationship between
the two wheat subspecies (spelt and other common wheat subspecies).
Accordingly, no meaningful clinical data are yet available that would effectively substantiate
any claim for a lower allergenic potential for spelt compared with other common wheat subspe­
cies.
Since commercially available spelt can therefore exhibit a level of allergenicity similar to that ofcommercially available wheat, the BfR recommends including a clear indication that spelt is a
type of wheat as part of applicable allergy labelling.
Question 2: If it is scientifically proven that commercially available spelt has the samelevel of allergenicity as commercially available wheat, are consumers aware of this8

https://link.springer.com/article/10.1007/s15007-018-1693-9, accessed on 12 November 2020

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www.bfr.bund.defact? From a scientific perspective, are those individuals who suffer from allergic reac­
tions to wheat protein the only group whose level of knowledge needs to be assessed?
A representative survey of the population was commissioned in order to answer questions re­lating to the level of knowledge and perception on the part of consumers in relation to spelt.
The survey was conducted from 11 to 12 November 2020, and included 1,014 individuals
aged 14 and over in private households in the Federal Republic of Germany. The survey wasembedded into a phone-based multi-topic survey (CATI omnibus survey) and conducted by amarket research company. To recruit participants, a dual-frame approach was used, which in­volved taking a random sample of landline and mobile phone numbers, also including tele­phone numbers not listed in telephone directories (in line with Working Group of German Mar­ket Research Institutes (ADM) guidelines). To ensure survey data were representative, data
were weighted according to gender, education, age, employment status, town/city size andGerman federal state (‘Land’).
To obtain answers to the above question 2, survey participants were asked to respond as fol­lows: “Do you think that people who are allergic to commercially available wheat products
would always be allergic to the following types of cereals as well?” Alongside spelt, rye and oat
were also offered as other types of cereals.
While common wheat (Triticum aestivum L. subsp. aestivum) and spelt (Triticum aestivum L.
subsp. spelta) are closely related and therefore could exhibit similar levels of allergenicity, only
22 percent of consumers surveyed stated that they thought individuals who are allergic tocommercially available wheat would always be allergic to spelt as well. A similar percentage of
responses was also found for rye (26%) and oat (21%), however (figure 1).
Figure 1 - responses to the question “Do you think that people who are allergic to commercially available
wheat products would always be allergic to the following types of cereals as well?”Basis: 1,014 respondents, responses as percentage

Of those respondents stating that spelt is a member of the wheat family (n = 521; see question3), only roughly a third (32%) stated that spelt would have the same level of allergenicity as
commercially available wheat. In contrast, more than half of respondents (60%) answered the@BfR, page 10 of 18

German Federal Institute for Risk Assessment

www.bfr.bund.dequestion as to whether individuals who are allergic to commercially available wheat would beallergic to spelt in the negative: 18 percent left the question unanswered or specified ‘Don’tknow’. This means that a majority of consumers are unaware that commercially available spelt
could have the same level of allergenicity as commercially available wheat.
It can be assumed that individuals diagnosed as wheat allergy sufferers and individuals diag­
nosed as coeliac patients have been generally informed by their attending doctor - and most
likely also by means of their own research (conducted with the corresponding professional or­
ganisations9, 10) - that they should avoid spelt as an allergenic and gluten-rich cereal, inde­
pendently of any specific knowledge on their part that spelt is indeed a member of the wheatfamily. The survey in question did not distinguish between those individuals who are allergic towheat protein and those who are not allergic to wheat protein. Accordingly, the survey cannot
be used to derive statements about the knowledge held specifically by allergy sufferers.
Since some online media sources have reported that spelt could offer an alternative to wheat
for wheat allergy sufferers 11,12,13,14, some wheat allergy sufferers could potentially resort tospelt products without having had a personal tolerance confirmed by a medical practitioner,
and therefore could expose themselves to the risk of an allergic reaction, which could - de­pending on individual circumstances - have serious consequences.
Alongside wheat allergy and coeliac disease, wheat sensitivity (non-coeliac gluten sensitivity(NCGS) or non-coeliac wheat sensitivity) is now frequently cited as another clinical syndromein this context (Reese et al., 2018). The pathological mechanism is unclear, however, andthere is a lack of meaningful diagnostic parameters. There has been heated debate for many
years now as to whether this is a separate, discrete condition and also regarding the constitu­
ent in wheat that is the relevant trigger. Among other things, undiagnosed coeliac disease isalso postulated as the cause of these symptoms (Reese et al., 2018).
An analysis of serum samples from participants in a study on the health of children and ado­lescents in Germany (KiGGS), which was conducted by the RKI from 2003 to 2006, has
shown that coeliac disease is likely to be severely underdiagnosed in Germany (Laass et al.,2015). The data expand the pool of nine children with confirmed coeliac disease by a potential
97 new cases. Accordingly, the prevalence of coeliac disease in children and adolescents inGermany is comparable with the prevalence in the general population in other European coun­tries and North America of roughly 1 percent. It can be assumed that individuals with undiag­
nosed coeliac disease, who wish to avoid wheat on account of symptoms arising from a pre­sumed wheat sensitivity, are not aware of the fact that they should also avoid spelt products.
From the perspective of health benefits, it would be useful for these individuals, until a final di­agnosis has been made, if spelt were clearly identified as a type of wheat. As a general point,

9

https://www.daab.de/ernaehrung/nahrungsmittel-allergien/ausloeser/uebersicht/weizen/, accessed on 17 November 202010

https://www.dzg-online.de/glutenfrei-leben--­diaet.213.0.html, accessed on 17 November 202011

http://www.ernaehrung.de/tipps/nahrungsmittelallergien/allergie16.php, accessed on 17 November 202012https://praxistipps.chip.de/dinkel-unvertraeglichkeit-was-sie-darueber-wissen-sollten_114354, accessed on 17 November 202013

https://www.dinkelbäck-mobil.de/dinkel/19-weizenallergie, accessed on 17 November 202014

https://www.proplanta.de/agrar-nachrichten/verbraucher/welche-mehlsorten-sind-besonders-gesund_article1466425212.html,
accessed on 17 November 2020

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German Federal Institute for Risk Assessment

www.bfr.bund.deindividuals who suspect that they suffer from wheat sensitivity should have a differential diag­nosis performed to clarify the matter. Without a medically confirmed diagnosis, voluntary
avoidance of gluten (except in the case of unconfirmed coeliac disease) does not automati­
cally equate to a healthy diet (Reese et al., 2018; DGE, 2018).
From a scientific perspective, the level of knowledge needs to be assessed for a wider groupof individuals than those who explicitly suffer from allergic reactions to wheat protein. This isbecause individuals with undiagnosed coeliac disease, wishing to avoid wheat on account of asuspected wheat sensitivity, would benefit from the knowledge that spelt is a type of wheat.
For reasons of transparency, consumers who may wish to avoid wheat products for other rea­sons should also be informed that spelt is a member of the wheat family.
Question 3: Are consumers aware that spelt is a member of the wheat family?
The representative survey shows that only roughly half of all consumers surveyed assumed
that spelt is a wheat family cereal. However, this result was then also repeated for rye (50%)
and, to a lesser degree, for oat (42%). Of those surveyed, 36 percent stated that spelt is not awheat species. For all cereals, slightly more than 10 percent of respondents replied with ‘Don’tknow’ or gave no answer in each case (figure 2).
Figure 2: Response to the question “Do you think that the following cereals are members of the wheat ce­
real family?”

Basis: 1,014 respondents, responses as percentage

These findings lead one to conclude that there is a low level of public knowledge in Germany
in relation to the genetic classification of cereals. While half of respondents correctly statedthat spelt is a member of the wheat family, this statistic should be seen in the context of thefact that many respondents also said the same about rye and oat, which are not members of
this genus.

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3.5

Other aspects

Alongside health protection, a further aim of food labelling is to guard against misinformationand therefore achieve greater clarity for the labels provided on food packaging.
The representative phone survey conducted by the BfR has shown that only roughly half of all
consumers surveyed assumed that spelt is a member of the wheat family. In light of this fact, aclear formulation in labelling, stating that spelt is a wheat cereal, is also advisable for consum­
ers for reasons of transparency, since these individuals may wish to avoid wheat products formany different reasons.
The BfR believes there are good arguments for considering terms such as ‘spelt wheat flour’
as being likely to result in confusion among consumers, as consumer surveys on the portal ‘le­bensmittelklarheit.de’ have indeed already shown.15,16,17 In this case, consumers tended to as­sume that ‘spelt wheat flour’ probably refers to mixtures of spelt flour and wheat flour, with‘wheat’ also being overlooked as part of the term.
Accordingly, the BfR recommends following the recommendation of the Working Group of
Food Chemistry Appraisers for the Länder and the Federal Office of Consumer Protection andFood Safety (ALS), which proposed the following two sets of wording in a statement on theclarification and improved intelligibility of spelt labelling adopted in their 113th session (2019):‘spelt flour (type of wheat)’ or ‘spelt flour (spelt wheat)’ (ALS, 2019).
The BfR considers the first new wording proposed by the ALS - ‘spelt flour (type of wheat)’ - aslikely to be better understood by consumers, with the term ‘spelt flour’ possibly being replacedby the more general term ‘spelt’. Accordingly, the recommendation would therefore be ‘spelt(type of wheat)’ or ‘spelt flour (type of wheat)’.
In the opinion of the BfR, the second wording proposed by the ALS - ‘spelt flour (spelt wheat)’ is less suitable for the purposes of improving intelligibility, since it cannot be assumed that
consumers are actually aware of what ‘spelt wheat’ is referring to.
The BfR also considers a clear statement that spelt is a wheat to be crucial for spelt labelling
because adults may experience severe anaphylactic reactions with respiratory and/or cardio­
vascular symptoms as a result of consuming products containing wheat cereals (Dölle et al.,2012).

Further information on the topic of allergies is available from the BfR website:
Overview page on the topic of allergies:
https://www.bfr.bund.de/en/a-z_index/allergies-129835.html

15

https://www.lebensmittelklarheit.de/produkte/allergenkennzeichnung-wie-weizen-dinkel-oder-dinkelweizen-bei-lebensmittelnmit-dinkel, accessed on 16 November 202016

https://www.lebensmittelklarheit.de/forum/kennzeichnung-dinkel-weizen, accessed on 16 November 202017

https://www.lebensmittelklarheit.de/forum/weizenmehl-dinkelmehl, accessed on 16 November 2020

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www.bfr.bund.de4

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About the BfR
The German Federal Institute for Risk Assessment (BfR) is a scientifically independent institu­
tion within the portfolio of the German Federal Ministry of Food and Agriculture (BMEL). The
BfR advises the Federal Government and the States (‘Laender’) on questions of food, chemi­cals and product safety. The BfR conducts independent research on topics that are closely
linked to its assessment tasks.
This text version is a translation of the original German text which is the only legally binding
version.

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