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Gluten Allergy Symptoms
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Gluten intolerance symptoms are common to a lot of bowel diseases, but can be an exclusive problem too. The symptoms of gluten sensitivity are often described by a sufferer as gluten allergy symptoms, but whilst the two names are used synonymously, there are differences between the two which I will outline for you. In fact, there are actually 3 different conditions associated with gluten and I will outline all 3 in due course for you. So, to understand the conditions you first need to know:
What Is Gluten?
Gluten 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. The gluten is a glue-like substance and provides both the chewiness and the binding to the product.
Its not just gluten foods that you need to be wary of though as contamination of other food products can also occur giving rise to symptoms of gluten intolerance . 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 pollenisation and equipment contamination.
What is Gluten Intolerance
The Three Conditions Associated With Gluten Problems
The Three Conditions Associated With Gluten Problems
As mentioned there are three problems that can occur from foods with gluten . These are gluten allergy symptoms, non-celiac gluten intolerance and celiac disease itself. Below, I have summarised each of these for you in more detail:
Gluten allergy symptoms
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 gluten 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 and this results in widespread symptoms of gluten allergy . There can be both local symptoms to the gut and also “systemic” to the rest of the body.
Bowel symptoms include abdominal pain and diarrhea and the systemic symptoms 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 (see list of foods containing gluten ) and to treat acutely with drugs such as antihistamines, steroids and adrenaline.
Fortunately, this condition is rare unlike the more common food allergy associated with peanuts normally referred to as peanut allergy.
Non-Celiac-Gluten Intolerance
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 allergy 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, diarrhea and tiredness.
Non-celiac gluten intolerance is common to a lot of bowel conditions and is commonly seen in 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.
Non-celiac gluten intolerance symptoms are diagnosed by the history and examination of a person suffering bowel symptoms associated with gluten foods without evidence of gluten allergy symptoms and negative investigations for celiac disease.
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.
Diagnosing Gluten Allergy Symptoms Vs Non-Celiac Gluten Intolerance Vs Celiac Disease
To diagnose potential gluten allergy symptoms is relatively straight forward. First, you need to have the symptoms associated with gluten allergy 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, gluten allergy symptoms 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 or Non-Celiac gluten intolerance symptoms, there is no investigation to diagnose the condition. It is purely diagnosed on the symptoms with the absence of positive celiac investigations.
Treating Gluten Allergy Symptoms, Non-Celiac Gluten Intolerance and Celiac Disease
No matter which condition you have, the main treatment for all these conditions is avoiding gluten foods (see list of gluten free foods ). There are many foods with gluten in, 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 in gluten and develop symptoms of anaphylaxis.
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