What is the difference between a 'gluten' allergy and celiac disease?

Lately, it seems like everyone is talking about gluten free products. What is gluten exactly and does it need to be avoided by all?

Gluten refers to a family of proteins found in the grains of wheat, barley, and rye. Celiac disease is a form of gluten intolerance, but strictly speaking, it is not an allergy. It is a rather a complex immune phenomenon involving antibodies that the body produces when someone eats gluten. These antibodies lead to damage of the lining of the small intestine, which can affect absorption of foods and can lead to malnutrition.  

Most kids with celiac disease will have abdominal symptoms when they ingest gluten. Some will also have a rash similar in appearance to eczema. There is a genetic component to celiac disease, it tends to run in families, and is more common among Caucasians than among other racial and ethnic groups. The best way to diagnose celiac disease is by blood test to measure IgA levels against gluten components.  The only real treatment is to remove gluten – primarily wheat – from the diet. People with celiac disease who avoid gluten usually do quite well, but approximately 15 percent of patients will have non-responsive celiac disease.

A wheat allergy is different from celiac disease. A wheat allergy occurs when IgE antibodies to wheat are present, and can cause symptoms that are different from celiac disease. The proteins to which these antibodies are directly may be different from those in celiac disease. This type of allergy can be diagnosed with a skin test or a blood test for IgE levels to wheat. In severe cases, a true wheat allergy can result in anaphylaxis. The signs are usually a rash, vomiting, abdominal pain, wheezing and/or circulatory collapse. The treatment is strict avoidance of wheat, careful reading of labels, and to have an epinephrine autoinjector with the patient at all times.

Recently, some celebrities and athletes have touted the benefits of a gluten-free diet. World champion tennis player Novak Djokovic describes in his book how maintaining a gluten free diet propelled his rise to the top of the tennis world. Many other people have perceived an improvement in their health even though they have tested negative for celiac disease. This has resulted in a new condition, called non-celiac gluten hypersensitivity, for which there is no conclusive diagnostic test. As with any nutritional regimen, you should avoid wheat if you don’t seem to tolerate wheat. However, if you can tolerate and enjoy it, there’s no reason to avoid it. “Gluten-free” does not necessarily equal “healthy.”


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