Over the past decade, more people are interested in gluten-free diets in order to get relief from a variety of symptoms. It is therefore important to know a little about the differences between celiac disease, gluten sensitivity, and true wheat allergy.
CELIAC DISEASE (CELIAC SPRUE; NONTROPICAL SPRUE; GLUTEN ENTEROPATHY):
Gluten is a protein normally present in wheat, rye, and barley. Gluten is what gives dough its elasticity, ability to rise, and contributes to the dough’s chewiness. It is found mainly in foods, but may also be found in everyday products such as medicines, hair products, vitamins, cosmetics, lipsticks and lip balms, and other dermatologic preparations. Gluten is found in so many unexpected foods as additives and can be found in unsuspecting foods such as beer, ketchup, ice cream, soy sauce, processed lunch meats, to name a few. Celiac disease is a hereditary (runs in families) autoimmune disorder of the small intestine found in all age groups (infancy through adulthood) that occurs in approximately as many as 3 million Americans. It occurs when people with celiac disease eat gluten. Their body’s immune system reacts to the gluten by attacking the lining of their small intestine. The immune system’s reaction to gluten damages small, fingerlike growths called villi. When the villi are damaged, the body cannot get the nutrients it needs.
Symptoms of celiac disease can include:
- Abdominal pain/cramping
- Extreme tiredness/fatigue
- Change in mood/depression/irritability
- Weight loss/decreased appetite
- Joint pains
- Iron deficiency anemia
- Osteoporosis due to decreased absorption of calcium
- Very itchy skin rash with blisters (Dermatitis herpetiformis)
- Delayed growth in children
The diagnosis is suspected when blood tests detect elevated levels of certain antibodies to gluten. An upper endoscopy is needed to confirm the diagnosis, as one needs a biopsy that shows the abnormal villi of the small intestine.
The only treatment for celiac disease at this time is avoidance of gluten in diet. When it is no longer exposed to gluten, the villi of the small intestine heal and can absorb nutrients again.
NON-CELIAC GLUTEN SENSITIVITY (NCGS) (GLUTEN SENSITIVITY; GLUTEN INTOLERANCE):
“Non-celiac gluten sensitivity” (NCGS) is used to describe individuals who cannot tolerate gluten as they experience the same symptoms as those with celiac disease. The main difference is that individuals with NCGS do not have the gluten antibodies in the blood and there is no villi damage in the small intestine as is seen in celiac disease. Research suggests that non-celiac gluten sensitivity is an innate immune response (nonspecific first line of defense), as opposed to an adaptive immune response (or “learned” response such as an autoimmune reaction) or allergic reaction. As many as 18 million Americans may have NCGS.
People with NCGS can also have other symptoms such as headache, “foggy” feeling in the head, lack of concentration, and numbness in the legs, arms, and/ or fingers. Symptoms typically appear hours or days after gluten has been ingested, a response typical for innate immune conditions.
New research shows that it is possible that gluten may not even be responsible for the symptoms produced by NCGS. FODMAP’s (fermentable oligo-, di-, and monosaccharides and polyols), a group of poorly digested carbohydrates, may be the cause of the symptoms instead. It is also interesting to note that wheat, rye and barley – the 3 grains that contain gluten – are all high in FODMAP’s. Even though wheat, rye, and barley contain high amounts of FODMAP carbohydrates, many other foods such as peaches, apples, beets, garlic, onion, asparagus, kidney beans, soybeans, milk, ice cream, and many sweeteners (fructose, mannitol, agave, sorbitol, etc.) also contain high amounts of FODMAP’s.
There are currently no confirmatory tests for NCGS and the diagnosis is by ruling out other conditions that may cause similar symptoms. As stated above, blood tests and biopsies that are positive with celiac disease are normal in these individuals. Improvement of one’s symptoms when gluten is removed from the diet makes NCGS more likely. However, there is a risk of self-diagnosis and starting oneself on a gluten-free diet. The risk is that there may be a serious gastrointestinal and/or other disorder that will be missed without the proper work-up. It is therefore important for individuals with these symptoms to see their physicians so that serious disorders can be ruled out by using proper testing to exclude them. Assuming there is no other disorder, a gluten-free diet and a FODMAP-free diet may be beneficial.
One or more of the wheat proteins, albumin, globulin, gliadin, or gluten, can cause an allergic reaction involving IgE antibodies. The reactions usually take place within a few minutes to several hours after exposure to the allergen. The symptoms may include some or all of the following: itching in the mouth, swelling of lips and/or tongue, hives, eczema, runny or stuffy nose, itchy or watery eyes, tightening of the throat and/or trouble breathing, wheezing, drop in blood pressure, vomiting, diarrhea, abdominal cramps, abdominal pain, and/or anaphylaxis.
A thorough medical history and physical examination in conjunction with skin prick tests and/or allergen-specific IgE blood testing are useful in the diagnosis of wheat allergy. A food challenge may be necessary in some individuals. For wheat allergy, strict avoidance of wheat and wheat products is necessary.
Although classic IgE-mediated allergic reactions are most common with wheat, non-IgE-mediated reactions to wheat may occur, usually with a slower onset of symptoms and these symptoms are generally confined to the gastrointestinal tract.
The board certified allergists at Black & Kletz Allergy can provide answers to your questions and offer evidence based diagnostic and treatment options. We have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for many years. We have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. Each of our 3 convenient office locations has on-site parking and the Washington, DC and McLean, VA locations are easily accessible by the Metro. Black & Kletz Allergy has been diagnosing and treating wheat and other food allergies for over 50 years. We also have the expertise to help diagnose and treat many gastrointestinal diseases associated with allergies and autoimmune disorders as well as rule out food allergies as a source of your gastrointestinal problems. Please call our office for an appointment if you have any of the above symptoms or alternatively, you can click Request an Appointment and we will be in touch with you within 24 hours of the next business day.