Celiac Disease vs Non Celiac Gluten Sensitivity vs

Wheat Allergies October 5, 2015

By Emily Hullinger

Learning ObjectivesDifferences between Celiac Disease, Non Celiac Gluten Sensitivity,

and Wheat allergies.

Identify signs and symptoms of Celiac Disease, Non Celiac Gluten Sensitivity, and Wheat allergies.

Diagnosis of Celiac Disease, Non Celiac Gluten Sensitivity, and Wheat allergies.

What is Celiac Disease (CD)?Lifelong, genetically based autoimmune disorder causing

inflammation of the proximal small intestine.

T-cell mediated immune response to gluten from wheat, rye, and barley which can lead to villous atrophy, crypt hyperplasia and inflammation in the small intestine.

Prolamins: gliadin, secalin, horedin, and sometimes avenin.

Development of Celiac DiseaseTwo main conditions must be necessary for development:The ingestion of gluten.Genetic predisposition to celiac disease.

The Human leukocyte antigens (HLA) found in CD positive patients are HLA DQ2 and HLA DQ8.

Some people have these HLA alleles but most do not develop CD

Symptoms of Celiac DiseaseDiarrhea, flatulence, intestinal bloating, steatorrhea, weight loss,

recurrent stomatitis, anemias or peripheral neuropathy.

Arthritis, muscle pain, dental enamel defects, osteopenia/osteoporosis.

Women: infertility, spontaneous abortions, fetal neural tube defects, and low infant birth weight.

Dermatitis HerpetiformisPruritic lesions that occur over the surface of elbows, knees, legs, buttocks, trunk, neck, or scalp.

How is Celiac Disease Diagnosed?

Testing for celiac disease involves a celiac blood test and biopsy sample from multiple areas of the intestine, including the duodenal bulb. IgA anti-TG2 antibody, IgG/IgA anti-demaidated gliadin antibody indicate Celiac

Disease.

Family medical history, physical exams, and a skin biopsy can also help diagnose CD.

If someone is suspecting CD, they must be consuming gluten in their diet for accurate results.

MNT for CDStrict GF diet (eliminating wheat, rye, barley and sometimes oats)

Defects from consumption are permanent. Once mucosa of SI is damaged, it cannot be reversed.

Greek-Mediterranean diet with olive oil, nuts, fruits, and vegetable intake.May prevent nutrition deficiencies: iron deficiency anemia, protein-

calorie malnutrition, zinc, folic acid, selenium, and vitamins B6, B12, D, E, and K.

What is Non Celiac Gluten Sensitivity (NCGS)?

The cause of NCGS is not-well understood and may be different for each individual patient.

Etiology and pathophysiology is still being researched.

A form of gluten intolerance that does not meet diagnostic criteria for celiac disease or wheat allergy.

Symptoms of Non Celiac Gluten Sensitivity

Gastrointestinal symptoms:Diarrhea, abdominal discomfort, pain, bloating, and flatulence.Malnutrition of nutrients due to decreased absorption of gluten.

Extraintestinal symptoms:Fatigue, headache, brain fog, lethargyDermatitis, skin rashes.

Sensitivities do not cause permanent GI or organ damage once the acute reaction is resolved.

How is Non Celiac Gluten Sensitivity Diagnosed?

No specific blood tests for this condition, still under investigation.When doctors have rules out Celiac Disease and Wheat allergy.Pre-requisites that may indicate NCGS:

Serologic negativity to anti-transglutaminase IgA and anti-wheat component IgE antibodies

Absence of duodenal atrophies and skin reactions from a prick test.

Lundin KEA, Alaedini A. Non-celiac Gluten Sensitivity. Gastrointestinal Endoscopy Clinics of North America 2012;22(4):723–734.

MNT for Non Celiac Gluten Sensitivity

Trial wheat, barley, rye and oat products.Eat gluten products as tolerated.If omitting gluten products:

Aim for a diet higher in B vitamins, iron, protein, zinc, folic acid, selenium, and vitamins D, E, and K.

What is a Wheat Allergy?Immune-mediated overreaction to proteins found in wheat

products. IgE-mediated reaction to the water and salt-insoluble gliadins,

specifically ω-5 gliadin.ω-5 gliadin can cause wheat-dependent exercise-induced anaphylaxis

or “Baker’s asthma”.

Symptoms of Wheat AllergiesSwelling, itching, and irritation of mouth, nose, eyes and throat.Rashes, hives, and swelling of the skin.Wheezing, difficulty breathy, anaphylaxis of the respiratory tract.Cramps, emesis, gas, bloating, diarrhea, and abdominal pain.

Wheat Allergies do not cause permanent GI or organ damage once the acute reaction is resolved.

How are Wheat Allergies Diagnosed?

Skin Prick testsBlood testOral food challengeFood eliminations

MNT for Wheat AllergiesAvoid products with wheat.More liberal diet than CD, patients do not need to restrict

other prolamin-containing grains (rye, barely, and oats). Ideal to have epinephrine available with meals in case of

anaphylactic (life threatening) reaction.

Questions?