Many faces of wheat allergies

The other day I had three patients independently and spontaneously tell me they had discovered they are allergic to wheat.
I've seen a lot of people make huge improvements by removing foods that bother them, and frequently suggest allergy testing or an elimination diet to root out these problems. The interesting thing on this day was the diversity of the symptoms that resolved with removing wheat from these people's diets.
One patient found that when he went off wheat, his thinking became much clearer (he's been diagnosed with bipolar disorder and attention deficit) and he stopped using the lithium he had been prescribed since he didn't need it any more. In addition, his chronic runny nose and reflux symptoms went away, problems he was having with dry skin on his face resolved, he lost weight and he's performing much better at work. Upon re-challenge with wheat, he started getting a dry rash on his face which resolved with avoiding wheat again.
Another patient found that his chronic eczema and hives improved when he stopped eating wheat.
The third patient eliminated wheat and this was the only thing that improved her intense sugar cravings that had originally brought her in. She also found an improvement in her energy levels and that re-challenge with wheat makes her feel terrible and gives her a runny nose, canker sores and fatigue.
Unfortunately, I don't have consistent testing between these three people due to individual circumstances and finances. Gliadin antibodies (from conventional labs) on all three were negative (gliadin is one part of the gluten protein that can trigger gut reactions). IgG and IgE antibodies (through a conventional lab) on one patient showed moderate IgE antibodies to wheat (this is characteristic of eczema) and very low IgG antibodies to wheat. One patient had a combined IgE/IgG4 antibody test through a specialty lab that did show high levels of antibodies to wheat and gluten. I have had other patients who didn't turn up any positives to conventional IgG/IgE testing despite profound symptoms that improved with removing wheat.
On the heels of this, an article came out in
American Family Physician (a journal for family docs) that maintains the doctrine that only IgE mediated reactions (which can be elicited with skin-prick testing) are food allergies and that most things that are called food allergies aren't. While that may satisfy allergists (for whom skin-prick testing is a significant part of their office income), it does little for the patients who have sensitivities to foods that don't show up on skin testing, and they are often dismissed by physicians who don't know that there is more to it than just IgE reactions. Some of the early work on food allergies was done by allergists, but the specialty has veered over to simple skin testing (which rarely shows food allergies) as the standard for allergy testing, leaving all the patients who don't show up with it out in the cold.