In General Knowledge for the Family, Physical & Mental Health

Gluten Allergy, Intolerance, or Celiac?

Gluten is a protein found in grain products. Ingesting gluten can cause immediate allergic responses in some people who are allergic to it. For others, over time ingesting gluten can cause widespread systemic responses to the protein that are classified as gluten intolerance and possibly even celiac disease. While these conditions vary in severity, symptoms of gluten allergy, and diagnoses, the treatment is the same: adherence to a strict gluten free diet to prevent allergic reactions and damage to the digestive system.

What is a Gluten Allergy?

Gluten allergies are on the rise around the world. A gluten allergy is a type of food allergy where the body’s immune system treats the substance like a foreign invader instead of a food substance. Ingesting a food that you are allergic to triggers an immune system antibody response by the body.

Only eight foods account for 90 percent of all food allergies. These foods are:

  • Peanuts
  • Tree nuts, like cashews, pistachios, pecans, almonds, and hazelnuts
  • Fish
  • Shellfish
  • Soy
  • Milk
  • Eggs
  • Wheat

In general, allergic reactions are usually caused by the proteins in these foods. Gluten is the substance in wheat that can cause an allergic reaction. Gluten is a protein found in grains such as wheat, barley, and rye. A gluten allergy is sometimes confused with celiac disease, but these are different conditions. An allergic reaction involves a reaction from the immune system. Celiac disease is an autoimmune disorder that can lead to serious damage in the small intestine. Celiac disease is similar to an allergy in that the patient must avoid all types of gluten in order to live a healthy life.

Gluten allergy symptoms

According to the European Food Information Council, symptoms of allergic reactions include respiratory, skin, gastrointestinal, and systemic problems.

Respiratory

  • Runny nose or sinus congestion.
  • Sneezing.
  • Asthma symptoms.
  • Coughing and wheezing.
  • Breathing difficulties which may become very severe.

Skin

  • Swelling, particularly of the lips, mouth, tongue, face, and/or throat.
  • Urticaria, or hives.
  • Rashes or redness on the skin.
  • Itchy skin.
  • Eczema, or dry, scaly skin.

Gastrointestinal

  • Abdominal cramping.
  • Diarrhea.
  • Nausea and/or vomiting.
  • Bloating.

Systemic

  • Anaphylactic shock:  This is a severe, system-wide shock that usually involves at least two of the systems above. It also can include a severe, sudden drop in blood pressure. Anaphylaxis is life-threatening and requires immediate treatment with an epinephrine auto-injector and treatment by emergency medical personnel.

Symptoms of a gluten allergy may include any of these symptoms depending on the severity of the allergy. Gluten allergy symptoms in women may include menstrual and hormonal problems as well.

Testing for gluten allergy

A gluten allergy test is used to diagnose allergy in children and adults who display signs of gluten allergy.  According to the American College of Allergy, Asthma, and Immunology, some symptoms of gluten allergy such as stomach cramps, diarrhea, and gastrointestinal symptoms overlap with those of celiac disease. Diagnosis of a food allergy is usually done through a skin prick test or a blood test. A qualified allergist can conduct either of these tests in his or her office.

The allergist will first take a patient history. He or she will ask questions about symptoms and family history. Some questions may seem like they are off topic, but are important indicators of food allergy. For example, those who had severe eczema as a baby are morel likely to develop food allergies later in childhood. Those who have parents with food allergies are more likely to suffer from them as well.

The allergist will then choose whether to conduct the skin prick test of the blood test. In the skin prick test, a small amount of liquid containing the suspected allergen is placed on the skin, usually on the back or forearm. The technician will then use a small, sterile probe to allow the protein to have contact with the blood. If a raised welt occurs in that site within 20 minutes, then the person is considered allergic.

In a blood test, a sample of the patient’s blood is sent to a lab to detect the presence of immunoglobulin E antibodies which would also indicate an allergy.

Lastly, if either of these tests is inconclusive, the allergist may order an oral food challenge to be conducted in his or her office. In this case, the patient would ingest the suspected allergen under medical supervision and be observed for subsequent symptoms and reactions.

Gluten intolerance

While not a full blown allergic reaction, some people find that they are sensitive to the gluten protein and that by eliminating it they feel better. This is generally referred to as a gluten intolerance. Gluten allergy symptoms in adults may include any of these signs of gluten intolerance.

Some signs of an intolerance to gluten include:

  • Gastrointestinal effects such as bloating, diarrhea, and constipation.
  • Malabsorption of vitamins indicated by low levels of iron in the blood.
  • Gluten allergy rash called keratosis pilaris and dermatitis herpetiformis are itchy skin rashes that appear across the body, commonly on the torso, arms, and elbows.
  • Migraines that begin within hours of ingesting gluten.
  • Joint pain caused by a system wide inflammatory response by the body. This pain is sometimes misdiagnosed as rheumatoid arthritis.
  • Lactose intolerance.
  • Chronic fatigue despite getting adequate sleep.
  • Fibromyalgia, or widespread pain throughout the body.

Testing for a gluten intolerance can be done through blood tests that measure the levels of iron and vitamins in the system.  The simplest and most common method of testing for gluten intolerance is to simply eliminate the substance from the diet for a period of time to see if symptoms improve. The individual can then decide whether or not to reintroduce gluten to the diet to see if the symptoms return.

Testing for Celiac Disease

Because gluten is also central in celiac disease, we should briefly discuss the testing involved for it as well.  Those who suspect celiac disease should discuss their concerns with their medical professional.  Their doctor may conduct a tTg-IgA test to screen for antibodies in the blood that are specific to celiac disease.  If this test is positive, the doctor will then recommend a biopsy of the small intestine to check for damage.  The biopsy is crucial to a celiac diagnosis.

Eating a gluten free diet

Avoiding gluten is the only way to avoid a reaction if you are allergic to the protein.  You cannot take medicine to prevent a reaction. Instead, you must eliminate the substance from your diet. Gluten can be found in unexpected foods such as lunch meats. Wheat also can be listed on the ingredient label under different names such as semolina, durum flour, farina, kamut, spelt, and graham flour.

According to the Mayo Clinic, foods to avoid (unless specifically labeled gluten-free) include:

  • Beers
  • Breads
  • Cakes and pies
  • Candies
  • Cereals
  • Communion wafers
  • Cookies and crackers
  • Croutons
  • French fries
  • Gravies
  • Imitation meat and seafood
  • Matzo
  • Pretzels
  • Pasta
  • Processed lunch meats
  • Salad dressing
  • Sauces, including soy sauce
  • Seasoned rice mixes
  • Processed and seasoned snack foods like tortilla chips
  • Self-basting poultry
  • Soups and soup bases
  • Vegetables in sauce – canned or frozen
  • Food additives such as malt flavoring
  • Medications and vitamins that may use gluten as a binding agent

You do not have to give up all grain based foods on a gluten diet.  The Mayo Clinic suggests using the following grains in your cooking:

  • Amaranth
  • Arrowroot
  • Buckwheat
  • Corn and cornmeal
  • Flax
  • Specifically designated gluten free flours
  • Hominy
  • Millet
  • Quinoa
  • Rice
  • Sorghum
  • Soy
  • Tapioca
  • Teff

Using alternate grains can take some practice.  Finding the right flour for cookies and cakes can be challenging, but there are many websites devoted to gluten free recipes to help you.  Large recipe sites such as allrecipes.com, foodnetwork.com, and food.com, all have gluten free sections. Many smaller personal blogs also offer advice and recipes from personal experience of living with the allergy.

Cross contamination can be a serious concern for those with a gluten allergy. Cross contamination occurs when the surface or cooking utensils used to prepare your food come into contact with substances you are allergic to. For example, a knife used to cut a sandwich with wheat bread should not be used in the preparation of your food unless it has been thoroughly washed first to remove any lingering food particles.

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