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Celiac Disease

Clearing Up the Allergy Confusion

About Coping with Celiac Disease

Celiac disease is not food allergy. Rather, it is a disease of the digestive system that results in damage to the small intestine by interfering with the absorption of nutrients. Celiac disease is unique in that one specific food component – gluten – has been identified as the main culprit. Gluten is the common name for proteins in specific grains that are harmful to persons with celiac disease. These proteins are found in all forms of wheat (including durum, semolina, spelt, kamut, einkorn, and faro), and related grains, such as rye, barley, and triticale. Damage to the surface of the small intestine is caused by an immunologically toxic reaction to the ingestion of gluten.

Celiac disease is often confused with food allergy because so many of the grains and wheats that can cause food allergies are the same ones that cause celiac disease. A common symptom and side effect of celiac disease is Dermatitis Herpetiformis, a severe, itchy skin rash (not a skin allergy) of small dark spots that develop on the hands, arms, and legs of people with celiac disease.

Celiac disease is genetically passed down from generation to generation. It is estimated that up to 1 in every 133 persons in the U.S. is affected. Family members can be tested for celiac disease even if symptoms are not apparent. People with immunoglobulin A (IgA) deficiency should consult with an experienced pathologist to ensure proper diagnosis.

Celiac disease is often confused with food allergy because so many of the grains and wheats that can cause food allergies are the same ones that cause celiac disease.

The only treatment for celiac disease is lifelong avoidance of foods with gluten. When gluten is removed from the diet, the small intestine will start to heal and overall health is improved. Medication is normally not required. Consult your physician regarding specific nutritional supplementation to correct any deficiencies.

All people with celiac disease should be monitored by their physician to ensure compliance with and response to the gluten-free diet. Dietary compliance decreases the likelihood of osteoporosis, lymphoma, and other associated illnesses.

Adapting to the gluten-free diet requires some lifestyle changes. It is crucial to read labels, which are often imprecise, and learn to identify ingredients that may contain hidden gluten. Be aware that hidden gluten can be found in some unlikely foods, such as cold cuts, soups, hard candies, soy sauce, many low fat or nonfat products, and even licorice and jelly beans.

Wheat Allergy
Gluten allergy is often confused with celiac disease or other digestive disorders. However, wheat allergy refers to adverse reactions involving immunoglobulin E (IgE) antibodies to one or more proteins found in wheat, including albumin, globulin, gliadin, and glutenin (gluten). (The majority of reactions involve albumin and globulin. Gliadin and gluten are rarer.) Allergic reactions to wheat may be caused by eating foods with wheat or even by inhaling flour containing wheat.

Allergic reactions to wheat usually begin within minutes or a few hours after eating or inhaling wheat. The most commonly reported symptoms seen with this kind of allergy include atopic dermatitis (eczema), urticaria (hives), asthma, allergic rhinitis, anaphylactic shock, and digestive symptoms.

Diagnosis may be easy if a person always has the same reaction after eating wheat-containing food, but more often, the diagnosis is difficult because wheat is a common food. Diagnosis usually entails a detailed medical evaluation with laboratory tests (RAST, skin-prick testing). Elimination-challenge testing remains the most reliable method of diagnosis.

Avoidance of wheat and wheat-containing foods is the first step in the treatment of wheat allergy. Wheat allergic people who have sensitivity to gluten (or gliadin) should avoid other gluten-containing cereals, such as oats, rye, and barley. However, because wheat is a common food product, wheat elimination diets can be difficult to maintain. Children on wheat-restricted diets are severely limited in their selection of foods. Alternatives may be found in special health and diet stores and restaurants.

As with most allergies, avoidance is key. Make sure to read all labels for foods, medicines, cosmetics, creams, and ointments that may contain any type or amount of wheat. A history of allergic reactions shortly after exposure to wheat might suggest an allergy. However, this should be confirmed with a skin prick test or RAST. Talk to your doctor about a complete diagnosis.

 

Source: Asthma and Allergy Foundation of America, www.aafa.org

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2010.