Types of gluten disorders

Here we will explain the differences between coeliac disease, wheat allergy and gluten intolerance or sensitivity.  

A true food allergy causes an immune system reaction that affects numerous organs in the body. It can cause a range of symptoms, and, in some cases, an allergic food reaction can be severe or life-threatening. 

In contrast, food intolerance symptoms are generally less dramatic and often limited to digestive problems, although they can do damage over the long term. If you have a food intolerance, you may be able to eat small amounts of the offending item without trouble.

Wheat allergy is an allergic reaction to foods containing wheat. The allergic reaction can be caused by eating wheat and also, in some cases, by inhaling wheat flour. In contrast to a grass allergy, it is not the wheat pollen that triggers the allergic reaction, but rather the proteins in the wheat. 

Wheat allergy is quite a common allergy among young children, most of whom will outgrow it. Wheat allergies in adults, however, tend to be permanent. 

Gluten intolerance or non-coeliac gluten sensitivity (NCGS) are terms used to describe the condition of people who cannot tolerate gluten in their food and experience symptoms similar to those who have coeliac disease – but without the same kind of intestinal damage as occurs in most coeliac cases.  

The three conditions have in common the fact that they are prompted by reactions to proteins in cereals, and that the treatment is to avoid eating food with those proteins.  

For people with coeliac disease this will mean adopting a strict lifelong gluten free diet. People with non-coeliac gluten sensitivity must adopt a low gluten diet. Anyone with a wheat allergy must adopt an absolute avoidance of wheat.  

Most gluten free foods will be suitable for someone with a wheat allergy, but be careful for the presence of gluten free wheat starch. On the other hand, wheat-free foods could contain rye or barley, the two other cereals that contain gluten and which must be avoided by people with coeliac disease.  

Coeliac disease is quite different to wheat allergy and gluten intolerance in that it is an autoimmune disorder, in which the immune system directs antibodies to attack gluten. Coeliac disease is permanent, whereas allergies and intolerances can come and go during a person’s life.   

If you have wheat allergy, exposure to a wheat protein primes your immune system for an allergic reaction. A person can develop an allergy to any of the four classes of wheat proteins: albumin, globulin, gliadin and gluten. 

Some people with wheat allergy develop symptoms only if they exercise within a few hours of eating wheat. Exercise-induced changes in your body either trigger an allergic reaction or worsen an immune system response to a wheat protein. This condition, called wheat-dependent exercise-induced anaphylaxis (WDEIA), usually results in life-threatening anaphylaxis. 

Gluten intolerance or non-coeliac gluten sensitivity are terms used to describe the condition of people who cannot tolerate gluten in their food and experience symptoms similar to those who have coeliac disease – but without the same kind of intestinal damage as occurs in coeliac cases.  

Some people may be surprised when they are not diagnosed as having coeliac disease, given that they appear to have the symptoms associated with that condition, prompted by eating gluten. The answer may be that they have a gluten intolerance or sensitivity, and the treatment is essentially the same as for coeliac patients: adopt a gluten free diet. 

Irritable bowel syndrome (IBS) is a common condition that affects the digestive system and leads the sufferer to endure a variety of symptoms such as cramps, bloating, diarrhoea and constipation. Up to one third of people will suffer from IBS at some point in their lives, and for many it is a lifelong problem that has a big impact on their day to day. 

The exact causes of IBS are not clear and there is no specific cure for the condition. But in many cases sufferers identify certain foods that trigger the problem or worsen it. Among the most common trigger foods are those containing wheat and gluten, with dairy products, onions, nuts and caffeine-containing drinks also known to cause abdominal upset in IBS patients.  

If you consult with your doctor about a possible case of IBS, they may check whether you actually have coeliac disease. 

Coeliac disease, gluten intolerance and wheat allergy can have very similar symptoms, although the latter tends to cause swelling, irritation and hives on the skin, as well as possible abdominal pain. Whatever you think may be causing symptoms such as chronic diarrhoea, cramping, fatigue and the others connected with these conditions, you should go to a doctor before attempting to reach your own conclusions.  

In the case of suspected coeliac disease, the diagnostic process begins with a blood test. It is important that you do not remove gluten from your diet before this as the test depends on spotting antibodies resulting from the autoimmune reaction that causes coeliac disease. 

If the result is negative, it may be that you are gluten intolerant and it is worth trying a gluten free diet to see if your symptoms are alleviated. 

Wheat allergy can be diagnosed through a skin-prick test or a blood test.