Gluten is a protein found in rye, barley, and wheat. This highly variable and common protein can be present in a wide range of foods, from bread and crackers to salad dressings and artificial flavoring. If you experience adverse reactions after eating wheat, it can be tempting to avoid gluten altogether – but gluten-free products are far from a cure-all.
Improperly addressing symptoms (or delaying adequate treatment) of a wheat-related disease can cause long-term or severe side effects, making accurate clinical diagnosis a crucial step.
What is Celiac Disease?
Celiac disease is an autoimmune disorder affecting approximately 1 in 100 people across the globe – whether they are aware they have it or not. In an autoimmune disorder, your immune system is unable to distinguish between your body’s normal cells and foreign, potentially harmful cells.
When gluten is consumed, the immune system mistakenly attacks the villi within the small intestine. These small, fingerlike projections are designed to help with nutrient absorption and digestion. Symptoms and health risks associated with celiac disease include:
- Joint pain
- Abdominal pain
- Weight loss
- Nutritional deficiencies
Celiac disease can be difficult to diagnose. Along with a thorough medical history, there are two tests that can rule out whether a gluten hypersensitivity is linked to celiac disease. One option is to test your blood for antibodies that are produced during an autoimmune reaction. Individuals with celiac disease will have significantly higher levels of IgA or IgG antibodies. A second option is to take a small tissue sample of the small intestine. A lab will examine the biopsy and determine if the villi inside the small intestine are damaged due to this autoimmune disease.
What is Gluten Sensitivity/Intolerance?
Non-celiac gluten sensitivity (NCGS) is a newly recognized condition in which individuals experience adverse reactions after consuming wheat and other foods with gluten, but do not fall under a celiac disease or wheat allergy diagnosis. Recent research has shown that additional factors present in wheat may also play a role in non-celiac gluten sensitivity, making the term non-celiac wheat sensitivity (NGWS) more common.
Individuals who are diagnosed with NGWS may be sensitive to small carbohydrates present in wheat. Because gluten-free products contain much lower levels of these carbohydrates (FODMAPs), consuming gluten-free products often brings significant improvement in symptoms. These symptoms often include:
- Skin irritation
- Digestive upset
- Abdominal pain
Gluten Sensitivity/Intolerance Diagnosis
Many symptoms of NGWS overlap with symptoms from celiac disease or wheat allergy, making it difficult to diagnose. The best way to determine if you are suffering from NGWS is to clinically test for – and exclude – celiac disease and wheat allergy. Once these wheat hypersensitivities are ruled out, individuals can work with a skilled clinician to begin eliminating wheat or gluten from their diet and note any positive changes. Eating a diet based on low-FODMAP foods can also be included as part of treatment. Although somewhat counterintuitive, if celiac disease is suspected, it is important to continue including gluten in the diet for accurate testing. Consult an experienced clinician as soon as an issue is suspected.
What is Wheat Allergy?
A wheat allergy is an IgE-mediated allergy. Wheat allergy is not an autoimmune disorder (like celiac disease), though it does trigger an immune system response. The immune system reacts to wheat as a threat and releases IgE antibodies. As a result, individuals with a wheat allergy experience a variety of allergic reactions, with some occurring immediately and others occurring over a matter of hours or days after consuming wheat.
Symptoms of a Wheat Allergy Reaction
Symptoms of a wheat allergy can include:
- Hay fever
- Tissue swelling
- Skin itching or irritation
- Stomach cramps (and/or abdominal pain)
- Swelling of the tongue and/or the lips or around the eyes
- Nasal congestion
A severe wheat allergic reaction can trigger anaphylaxis, which can become life-threatening if not treated immediately. This occurs when the immune system sends a rush of chemicals to fight off invading proteins, causing anaphylactic shock. Signs of anaphylaxis include:
- Pale or bluish tint on the skin
- Throat constriction
- Shortness of breath (and/or wheezing)
- Difficulty breathing
- Confusion and/or dizziness
- Weak, rapid pulse
If an individual goes into anaphylaxis, epinephrine treatment must be sought immediately. If you have a diagnosed wheat allergy, consider using this downloadable form from FARE to create your own anaphylaxis emergency plan in case of accidental wheat ingestion.
Wheat Allergy Testing and Diagnosis
Allergic reactions to wheat may sometimes overlap with symptoms of celiac disease or gluten intolerance/sensitivity. Recent research even points to a possible link between wheat allergy and irritable bowel syndrome (IBS). What sets wheat allergy apart is that an allergic reaction can become severe, and may result in life-threatening anaphylactic shock. As a result, self-assessment or treatment of a suspected wheat allergy without obtaining a clinical diagnosis can present significant health and safety risks.
The gold standard of testing encompasses three ways to clinically determine whether someone has a true wheat allergy or should be evaluated for celiac disease, or a gluten intolerance/sensitivity.