Gluten allergy symptoms are specific and unusual, although a lot of people with Irritable Bowel Syndrome 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 and IBS.
The 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 allergy, intolerance and celiac disease.
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To understand all of these conditions and learn ways to prevent the sensitivity problems, you first need to know more about the substance itself:
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.
Foods that contain the protein are often process food products such as ready meals and not just in cereals.
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 cross pollination and equipment contamination.
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, your antibodies are raised against a specific allergen, predominantly immunoglobulin IgE.
In the case of gluten allergy symptoms, the allergen causing this is gluten.
Antibodies attach to the protein in your gut and blood stream.
These antibodies are then 'presented' to inflammatory cells such as eosinophils and basophils.
Your eosinophils and basophils then produce histamine and similar inflammatory mediators that stimulate blood flow to the affected area, mucus secretion and muscle contraction.
Fluid leaks in to your gut resulting in widespread gluten allergy symptoms. This can be both localised to your gut or “systemic” to the rest of your body.
Bowel symptoms include abdominal pain and diarrhea can occur.
Other '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 foods and to treat acutely with drugs such as antihistamines, steroids and adrenaline.
Fortunately for you, this condition is rare unlike other more common food allergies such as peanut allergy.
Wheals or Hives
Breathlessness and Wheeze
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 get 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, liver dysfunction, 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.
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 the protein 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. 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 the protein.
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 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.
wanted to share a great study that was published by the
American Journal of Gastroenterology, entitled "Gluten Causes
Gastrointestinal Symptoms in Subjects Without Celiac Disease: A
Double-Blind Randomized Placebo-Controlled Trial."
Link to the study: http://www.ncbi.nlm.nih.gov/pubmed/21224837
To sum up the study:
The participants used in the study were people that had been diagnosed with IBS, tested negative for Celiac disease, and were able to control their symptoms through the maintaining of a gluten-free diet.
For six weeks, participants were either given a gluten-containing diet, or one free of it.
What was found was that the majority of participants who received a it experienced a recurrence of IBS symptoms.
In conclusion, the study demonstrated that for some individuals, non-celiac gluten intolerance can indeed cause IBS symptoms.
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