Gluten allergy symptoms are specific and unusual, although a lot of people with bowel symptoms think they have it! On the other hand, intolerance is common and associated with a lot of different bowel diseases including inflammatory bowel disease, IBS and Celiac disease.
The gluten sensitivity symptoms are often described as an allergy, but whilst the two names are used synonymously, there are differences between the two which I will outline.
There are in fact 3 different conditions associated and these are gluten allergy, intolerance and Celiac disease. So, to understand all of these conditions and learn ways to prevent the sensitivity problems, you first need to know more about the substance itself:
Before I discuss allergy symptoms in more detail you need to understand more about gluten itself. This is a protein contained in wheat, rye and barley plus food products containing these natural products. It is the main bulking substance to each of these products and this makes it the ideal substance to use in food products.
Gluten foods are often contained in processed food products such as ready meals and not just in cereal products. It is a glue-like substance and provides both the chewiness and the binding to the product.
Its not just foods that you need to be wary of though as contamination of other food products can also occur too during processing. An example of this would be oats, a natural alternative to wheat as a cereal substitute. Oats don’t contain gluten, but because farmers often grow them near to wheat fields, cross contamination can occur through both pollination and equipment contamination.
As mentioned there are three problems that can occur. These are gluten allergy symptoms, non-celiac intolerance and celiac disease itself. Below, I have summarised each of these for you in more detail:
Allergy is a very specific entity. It is caused by your bodies own immune system in an exaggerated response to what it recognises as foreign. There are various immune responses, but the most important one is the immediate immune response or type 1 hypersensitivity reaction.
In a type 1 hypersensitivity reaction, the antibodies are raised against a specific allergen, predominantly the immunoglobulin IgE. In the case of gluten allergy symptoms, the allergen causing this is gluten.
Antibodies attach to the protein in the gut and blood stream and are presented to inflammatory cells such as eosinophils and basophils. These produce histamine and similar inflammatory mediators that stimulate blood flow to the affected area, mucus secretion and muscle contraction. Fluid leaks in to the gut resulting in widespread gluten allergy symptoms. There can be both localised to the gut and also “systemic” to the rest of the body.
Bowel symptoms include abdominal pain and diarrhea and the systemic features can include flushing, wheals or hives, swelling, breathlessness and anaphylactic shock. It can be so extreme in some cases that death results without urgent medical intervention including avoiding the gluten foods ingested and to treat acutely with drugs such as antihistamines, steroids and adrenaline.
Fortunately, this condition is rare unlike other more common food allergies such as peanut allergy.
Non-celiac gluten intolerance or NCGI is the most common condition that people suffer and likely to be the cause of your symptoms too. It is thought to affect up to 30% of the worlds population, so it’s very common. This condition isn’t an allergy so you don’t get the systemic response of flushing, wheals or urticaria and the potentially life threatening anaphylactic shock.
You do however get gluten intolerance symptoms including abdominal pain and cramps, distension or bloating, nausea, diarrhea and tiredness.
NCGI is common to a lot of bowel conditions including IBS or the Irritable Bowel Syndrome. It is also seen in conditions such as inflammatory bowel disease (Crohns disease and Ulcerative colitis), diverticular disease and other forms of bowel disease.
NCGI is diagnosed by the history and examination of a person suffering bowel features without evidence of gluten allergy symptoms and negative investigations for celiac disease.
Celiac disease is a 3rd condition associated with gluten and affects 1 in 300 people worldwide. The condition is characterised by similar symptoms to NCGI including abdominal pain, bloating or distension, diarrhea and tiredness. It is also associated with other features such as anemia, weight loss, the skin condition called dermatitis herpetiformis and other conditions such as liver dysfunction and hyposplenism and small intestinal lymphomas.
The condition affects the small bowel. The small intestine is lined with villi, thrond-like protuberances which are involved in absorption of nutrients by providing a large surface area. In celiac disease, the villi shrink resulting in a condition called sub-total villous atrophy. Loss of the villi result in malabsorption problems with the resulting symptoms outlined.
In celiac disease, antibodies are raised against the gliadins, a prolamin contained in gluten. These antibodies were the initial antibody test for celiac disease, although this has largely been superseded now by the antibody tests known as the anti-TTG or anti-tissue transglutaminase test and anti-EMA or anti-endomysial antibodies.
Celiac disease is classified as an autoimmune disease where the bodies host immune system inappropriately raises an inflammatory response to gluten with resulting small bowel damage. It is more common in other autoimmune conditions including diabetes mellitus, thyroid disease, vitiligo, pernicious anemia and rheumatoid arthritis.
To diagnose potential gluten allergy symptoms is relatively straight forward. First, you need to have the symptoms including abdominal pain with diarrhea and the systemic features of wheals, flushing, breathing problems +/ anaphylaxis. This needs to be associated with the intake of gluten.
To confirm the diagnosis you can perform either a skin prick test or a RAST test. A skin prick test involves presenting the allergen i.e. gluten by injecting a tiny amount intradermally or in to the skin. If you are allergic to this, a localised skin reaction will occur or localised wheal. The alternative is to perform a RAST test which involves taking a blood sample and measuring specific IgE antibodies raised against gluten.
By definition, symptoms of gluten allergy are not associated with celiac disease. Celiac disease is diagnosed via a positive gliadin antibody test or positive anti-TTG or endomysial antibody test. This is usually confirmed by taking a small bowel biopsy at endoscopy looking for sub-total villous atrophy. By definition, all these need to be absent in people with symptoms of gluten allergy.
With NCGI there is no investigation to diagnose the condition. It is purely diagnosed through the symptoms in the absence of positive celiac investigations.
No matter which condition you have, the main treatment for all these conditions is avoiding gluten. There are many foods which contain it, the main ones being bread, cakes, biscuits, beers and cereals such as shredded wheat, shreddies or wheaties.
If you have gluten allergy symptoms, you may need to be treated with antihistamines, steroids and epinephrine if you inadvertently take it in your diet and develop anaphylaxis.
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