Gluten Allergies

Medically reviewed by Natalie Olsen, RD, LD, ACSM EP-C on November 6, 2017Written by Michael Kerr

Gluten allergy vs. celiac disease

A gluten allergy — not to be confused with gluten sensitivity or celiac disease — is caused by gliadin (a glycoprotein). Gliadin and glutenin (another protein) are the two main proteins in the gluten protein family. Gluten is found in wheat and other related grains such as barley and rye. (Oats are naturally gluten-free but may be contaminated with gluten.)

Gliadin is also one of the major allergens associated with wheat allergies and is a trigger for celiac disease, a serious autoimmune disorder of the small intestine.

With a gluten allergy, small amounts of gluten may be tolerated, but with celiac disease, gluten can’t be tolerated at all. When someone with celiac disease eats gluten, their immune system malfunctions and begins to attack the body, causing high inflammation and eventually damaging the lining of the small intestine. This is why celiac is considered an autoimmune disorder.

Celiac disease restricts absorption of nutrients and may lead to weight loss and malnutrition. Because celiac disease shares symptoms with a number of other disorders, including a gluten allergy, it is important that a person be tested if gluten issues are suspected.

As many as 6 percent of Americans have gluten sensitivity. With gluten sensitivity (also known as gluten intolerance), there may be symptoms such as bloating, abdominal pain, or diarrhea, but, because the immune or autoimmune symptoms aren’t involved, it isn’t considered as serious a condition as celiac disease or gluten allergy. Around 1 percent of Americans have celiac disease.

Signs and symptoms

In adults

Symptoms of a gluten allergy are often similar to those in celiac disease and may include:

  • abdominal pain
  • diarrhea
  • constipation
  • fatigue
  • bloating
  • heartburn
  • anxiety
  • anemia

Additional symptoms of a gluten allergy may include:

  • trouble breathing
  • ulcers in the mouth
  • asthma
  • depression
  • osteoporosis
  • weight loss
  • rash
  • swelling of the lips
  • irritability
  • anaphylaxis (in extreme cases)

In children

A gluten allergy may look very different in children than in adults, so it’s important for parents to monitor their child's behavior and diet if they suspect a gluten allergy. Know, also, that this allergy may go into remission only to return in later years.

Children with a gluten allergy may experience eczema in addition to the symptoms listed above.

Diagnosing gluten allergies

Gluten allergies are notoriously difficult to pin down. Any number of conditions may cause symptoms similar to a gluten allergy, including gluten sensitivity and celiac disease. In addition, symptoms may vary greatly for a single individual (for example, from constipation to diarrhea).

The only way to find out for sure if someone has a gluten allergy is for them to be tested.

One of the most common tests to determine this is an elimination diet. In an elimination diet, you remove gluten-containing foods, such as wheat or pasta, from your diet for a period of time to see if symptoms resolve. These foods can later be reintroduced, one at a time, while looking for symptoms that show a reaction.

However, an elimination diet may not rule out celiac disease or gluten sensitivity. Listen to your body and pay attention to your symptoms during the elimination process. Working with your doctor or a registered dietitian can help you to effectively eliminate gluten, monitor symptoms, and then slowly reintroduce foods, if necessary.

Other ways to test for a gluten allergy include an IgE (cell-mediated) test, which times the body’s reactions to various allergens or skin tests.

A food allergy/intolerance blood test such as a skin prick test (SPT), prick-in-prick test, and lymphocyte activation test can positively identify whether or not a person has a gluten allergy.

A blood test, along with a stool test for gluten intolerance, is generally recommended because it is possible with these types of tests to have a positive reading for a food allergy to all of the grains containing gluten but a negative reading for gluten sensitivity — and vice versa.

Treatment

If a positive diagnosis for a gluten allergy is made — and celiac disease is eliminated as a cause of the symptoms — you can determine how much, if any, gluten can be tolerated in your diet. If you have a gluten allergy, avoiding gluten may resolve symptoms, increase energy, and generally improve your quality of life.

Digestive enzymes may be helpful for those who have a gluten allergy. One specific enzyme called dipeptidyl-peptidase IV (DPPIV) has been shown to efficiently degrade gliadin, which is the primary allergy-causing protein in gluten. These digestive enzymes can be found over the counter at most health food stores and may aid in the proper breakdown of gluten for those who are sensitive to it.

Diet

Wheat is the predominant grain product in the United States, so removing it from the diet can be very difficult for many people. Because barley and rye, among other grains, also contain gluten (and oats may be contaminated by gluten), the list of replacement grains becomes even smaller. Alternatives include:

  • amaranth
  • corn
  • quinoa
  • rice
  • tapioca

However, as the breadth of the health concerns associated with gluten are becoming more widely known, many restaurants and food-processing companies are offering an ever-larger selection of gluten-free options every day.

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