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    Quite Simple, Food Allergies vs. Food Intolerance


    Paul Smith

    Celiac.com 06/29/2009 - Hypersensitive reactions to food are becoming increasingly problematic in society. Allergy experts report that the prevalence of food allergies appears to be rising and while there are no exact figures for this in Australia, some studies have shown marked increases overseas.

    For example, a study from the Isle of Wight in the U.K. has shown a tripling in the rate of peanut allergies over the past 10 years. However, the reason for this is not yet clear.  Auckland allergy expert Dr. Vincent Crump has three theories regarding the increase in peanut allergies.

    More people are eating peanuts and, up until recently, many eczema creams contained peanut oil, possibly exposing an allergy prone person to the food.

    There’s also the 'hygiene theory' of disease, which suggests that children are not exposed to enough dirt and bacteria these days, and therefore do not build up a normal immunity to harmless substances. So when they are exposed, their immune system overreacts and they develop an allergy.

    Despite the overall increase in food allergies, the rate in adults is still pretty low – around one per cent. However, the rate is higher in children, where up to five per cent are believed to have a food allergy.

    Allergy vs. intolerance

    The most common and best understood type of allergy is a reaction in which the body's immune system overreacts to a food and mistakenly produces antibodies (called IgE) to the food.

    This can cause reactions, sometimes severe, that affect the skin, breathing, gut and heart.

    An intolerance is an adverse reaction to a food that does not involve the immune system. Symptoms are generally less severe, and can include headaches, gut problems and worsening of skin conditions such as eczema. Intolerance is much less likely to be life-threatening than a true allergy.

    What is an allergy?

    According to the Australian Society of Clinical Immunology and allergy (ASCIA) education resources website, the word “allergy” is frequently overused and misused to include any irritating or uncomfortable symptoms after eating.

    Strictly speaking the term should only be used for the symptoms which develop after eating certain foods as part of the immune response.

    In an allergic reaction, the body’s immune system mistakenly believes the food is harmful and tries to protect itself. In doing so it overreacts and produces, for example, harmful antibodies to fight the food “allergens”.

    In turn, these special antibodies (called IgE) make the body produce histamines and other chemicals, causing reactions that affect the skin, breathing, gut and heart.

    IgE antibodies can also “cross react “with other allergens. For example, someone with a latex allergy may also react after eating a banana, kiwi fruit or avocado. According to allergy specialist Professor Rohan Ameratunga, up to 50 per cent of people who react to one tree nut (including almonds, brazil nuts, Cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts) will react to other tree nuts.

    A recently recognized form of food allergy is the “oral allergy syndrome”, where a person experiences a cross reaction between pollens and fresh fruit and vegetables.

    This “cross-reactivity” is also the reason why some adults with a predisposition to other allergies suddenly develop a food allergy.

    For example, a person with a birch pollen allergy can suddenly became allergic to apple or kiwi fruit allergens.

    Dr Crump says more and more adults prone to allergies are developing cross reactions after they are overexposed to certain foods (such as acquiring wheat allergies after working in a bakery).

    What are the most common food allergies?

    Allergies are mostly triggered by nuts, shellfish, fish, milk, eggs, wheat and soybeans.

    Adults are more likely to be allergic to fish, shellfish and nuts, with children suffering more from allergies to milk, eggs and peanuts.  Reactions to seeds and fruits are also becoming more common.

    There are cultural differences in allergy patterns, according to professor Ameratunga.

    In Japan, rice allergy is common. In the Middle East and Australia, sesame allergy is on the rise.

    We know the treatment for coeliac disease is a gluten-free diet for life. Although people with coeliac disease produce antibodies the allergic process is different from that seen in most other allergic reactions.

    In coeliac disease, gluten reacts with the small intestine, and activates the immune system to attack the delicate lining of the bowel.

    The normally rippled lining of the intestine becomes damaged and inflamed, and forms the characteristic flat appearance of celiac disease.

    The surface area, which enables the absorption of nutrients and minerals from food, is seriously depleted, leading to gastrointestinal and malabsorptive symptoms.

    Common Intolerances

    Almost any food can cause an intolerance, but the repeat offenders are;

    OFFENDER:
    Lactose
    FOUND IN:
    Milk and milk products. Yoghurts have little lactose and hard cheeses have none.

    OFFENDER:
    Salicylates
    FOUND IN:
    Natural food chemicals found in a wide variety of fruits and vegetables such as cauliflower, eggplant, broccoli, tomato, apple, orange, and pineapple. Also found in nuts, spices and aspirin.


    OFFENDER:
    Amines
    FOUND IN:
    Histamines and histamine-like chemicals produced during fermentation, and the ageing and ripening of foods. Found in wine, processed meats, hard cheese, tomato paste, chocolate, and many fruits and vegetables.


    OFFENDER:
    Glutamate
    FOUND IN:
    An amino acid found naturally in all protein foods such as cheese, processed meats and milk. MSG (additive621) is a type of glutamate, and natural glutamates are also found in soy sauce, broccoli, mushrooms, spinach, tomatoes, grapes, plums and many others foods.

    Anything else you'd like to add?
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    Guest Carol Frilegh

    Posted

    Dr. Natsha Campbell McBride has written an article on this and provided a case study. Unfortunately it is not on the Internet. I have a scanned copy and will forward it to Scott.

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    Guest Paul Smith

    Posted

    Thanks Carol.

    Regards

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    Thanks Paul,

    I wish that I had read your article before the hundreds of tests showed me what my body kept telling me all along, that at various stages in my life I have been allergic to many different foods to the point where I've only been able to eat a combo of some 5 vegetables with a little fish and on occasion yogurt as long as I have digestive enzymes with it. That is still the case at the moment, but guess what? My body is finally starting to repair with all the allergy inducing foods taken out of the way.

    Why this is happening? Who knows?

     

    Thank you for your article, you've validated a lot of things for me which I inherently knew and which consistently was denied by drs and their (mostly very) inadequate tests.

    One eminent professor in Brisbane however tested 96 foods on me and sent me on my way with a list of five foods which according to his test I was able to tolerate. These five foods included tomatoes and potatoes which I haven't been able to eat for years and years.

     

    Btw I can eat most flowers, nasturtiums are yum!

     

    Thank you Paul, really enjoyed the article.

     

    Mimi

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    what about a casein allergy or intolerance? I see no mention of that but in children with aspd's or similar disorders this seems to be a prevalent issue.

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    Guest Paul Smith

    Posted

    Thanks Paul,

    I wish that I had read your article before the hundreds of tests showed me what my body kept telling me all along, that at various stages in my life I have been allergic to many different foods to the point where I've only been able to eat a combo of some 5 vegetables with a little fish and on occasion yogurt as long as I have digestive enzymes with it. That is still the case at the moment, but guess what? My body is finally starting to repair with all the allergy inducing foods taken out of the way.

    Why this is happening? Who knows?

     

    Thank you for your article, you've validated a lot of things for me which I inherently knew and which consistently was denied by drs and their (mostly very) inadequate tests.

    One eminent professor in Brisbane however tested 96 foods on me and sent me on my way with a list of five foods which according to his test I was able to tolerate. These five foods included tomatoes and potatoes which I haven't been able to eat for years and years.

     

    Btw I can eat most flowers, nasturtiums are yum!

     

    Thank you Paul, really enjoyed the article.

     

    Mimi

    Hi Mimi,

     

    I think it is very important to listen very carefully to what our bodies are telling us. Often when we feel reluctant to eat something it is because we know instinctively that it is not right for or disagrees with us and that it should either be eaten extremely sparingly if not totally avoided. Tomatoes and potatoes are both members of the “Deadly Nightshade†family along with eggplant (aubergines) and capsicums. Many people, myself included, have difficulties with these vegetables: they are often implicated in exacerbating arthritic symptoms. Some people also have a negative reaction to the natural alkaloids in potatoes. When we started in the gluten free area in the late 1980's we originally had potato starch in our gluten free flours. In response to some technical issues, negative feedback about the sulphur dioxide content and adverse reactions on the part of numerous consumers to the potato alkaloids we removed potato starch from our formulation. Some years ago, I found all my finger joints were becoming red, swollen, stiff and difficult to bend. I suspected the onset of arthritis and after a review of my diet, I cut back/halved my consumption of these vegetables and increased my intake of water and within a few weeks my symptoms had completely disappeared with my hands returning to and remaining normal under my new regime. However, it is a tragedy for you to be restricted to such a narrow range of foods. Have you by any chance been exposed to heavy doses of anti-biotics when you were younger? It sounds a bit as though you have lost a lot of your stomach bacteria and you may need assistance in restoring the balance to improve your digestive system. Did your parents have immune system problems? Did you have colic as a young child? Very often these factors can cause imbalances within the gut and predispose you towards Coeliac/Celiac Disease or to longterm Irritable Bowel Syndrome and quite possibly Chronic Fatigue Syndrome. There are various pre-biotic and pro-biotic supplements available which can assist in restoring the correct balance in your gut fauna and flora which may hopefully address some of your digestive issues. You may need to eat more slowly and to have smaller more frequent meals. You may need to be careful that you are digesting rather than fermenting your food. If you are a full blown and long term Coeliac/Celiac with delayed diagnoses some of the damage to your gut may be permanent and irreversible, no matter what else you do. Getting your diet right will provide relief from your symptoms but you may never make a full recovery. Unfortunately, I don't have sufficient information to comment authoritatively on your condition, nor am I a licensed medical practitioner or dietitian.

    Wheat, bread and gluten, for example, are all acid forming as are tea, coffee, dairy products, meat, soft drinks and alcohol. Excessive acidity reduces our ability to take up and utilise many minerals, vitamins and other nutrients, thereby exaggerating poor health conditions within the body.

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    Guest Paul Smith

    Posted

    Hello Gabi,

     

    You make a very good point in asking about dairy protein or casein intolerance. There are also other issues with milk products including anti-biotic and cortesone residues, lactose intolerance, difficulties with milk fat, sodium induced headaches and mucus formation. Protein allergies are implicated in most food intolerance issues: in allergies/intolerances to soy, dairy, wheat/gluten, peanuts, millet, sesame seeds, shellfish and crustaceans. These also often overlap with lactose intolerance, fructose malabsorption and other fermentable sugar(s) issues. In the case of A.D.D. and Autism, casein in combination with gluten is heavily implicated in the aggression, hyper activity and crankiness that characterise these chronic health problems and gluten appears to be implicated in the aggravation of epileptic fits. There are serious neurological issues involved in the consumption of both gluten and casein. Unfortunately, there are also enormous variations in individual tolerances to these and many other foods which only blood and genetic screening can give an indication of. Remove these two elements from the diet and the most individuals become very much more docile, sociable and manageable and their ability to learn and apply themselves improves significantly. A previously monster child can be transformed into a comparatively well behaved angel. There are issues with milk in that by continuing to drink and consume it we are one of the few species that, effectively, does not wean itself. The fundamental issue is that milk is designed to feed calves not human beings. I believe milk is OK if consumed sparingly. The trouble comes because in most instances we over consume it, as we tend also to do with bread, meat and most of our other staple foods. It is arguable that most of us eat from too narrow a food base which influences the degree of exposure to various food intolerance issues.

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    Hello

     

    With reading the article above and also the responses I was hoping for a bit of feedback on my current situation.

    As a child I was lactose intolerant however was OK in my teens. Now I seem to have gotten sick again and that allergy has now been recurring. I have had many issues with foods but have had many tests and everything negative. No food allergies no diabetes and no celiac disease. If I have a chocolate (small consumption of sugar) I feel slightly high but light headed and very tired about 20 minutes after eating it. I get very bloated if I have a small bit of bread. I have recently become very sore with my muscles and joints which are cracking and very sore.

    I was hoping someone could relate to this as ALL the doctors I go to seem to think I'm over doing things. I use to train at the gym excessively. However now I go only a few days a week if I have the energy to go and have put on weight I don't seem to be able to get rid of.

    Thanks

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    Hi,

    Very good article and consistent with what I understood about the differences between food allergies and celiac disease, until earlier this week. My 5 year old son has been on a gluten free diet since he was 10 months old because he had an allergic reaction to barley (facial swelling, hives, etc). He was allergy tested shortly after that time and tested positive to wheat on a RAST test. He was also tested for Celiac disease at the same time (1 year old) .... Unfortunately, our allergist neglected to share the results of this test with us until his appointment last week ( 5 year old) .... Yes, 4 years later! The blood test indicated that he tested positive for Celiac disease as well! .... It left me wondering (and led me to this site) to understand if he truly has both Gluten Food Allergies and Celiac disease ? ... It seems like an odd situation and perhaps an opportunity for false positives for the celiac blood test. ... Any insights anyone could offer would be greatly appreciated!

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    Guest Deselt

    Posted

    Informative article, just what I was looking for.

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    Guest Immuno Laboratories

    Posted

    More people are sensitive, rather than allergic, to a food. If you are sensitive to a food, your body may not react for several hours or even the next day. Food sensitivity symptoms are deceptive because you would not normally associate them with foods you have eaten. Headaches, chronic sinus congestion, aching muscles and joints or feeling drained of energy are all symptoms of food sensitivity reactions. Food sensitivities may even cause mood swings or affect your mental clarity. Irritability and a short temper may also be the result of food sensitivities. They are often related to food addictions and can be a cause of weight problems for a reason you wouldn't suspect.

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  • About Me

    I am 60 years old. An Architect and Landscape Architect by training, graduating in both in 1974. I have an MBA (Master of Business Administration Degree) from Melbourne University in 1990. My family have owned FG Roberts (a gluten free/soy products factory in Melbourne Australia) for 54 years. I have been employed by the company full time since 1980 in various technical, management, operational, product development, research and marketing roles. My Web site is: www.glutenfreehealth.net

  • Related Articles

    Scott Adams
    Introduction
    Through his writings, we know that Hippocrates, the father of medicine, had already recognized the presence of allergic reactions in people as early as ancient times. However, the term allergy is a relatively new one, as compared to many other commonly used medical terms. In 1906, Viennese pediatrician Baron Clemens von Pirquet used the term for the first time to describe an altered response of his patients bodies. Von Pirquet believed that this altered reaction manifested itself in changes of the immune system, effected by external influences on the body, such as: food intake, the air breathed or direct skin contact. The term allergen (the substance responsible for the altered reaction) was born. At that point in time, however, von Pirquet had no means of scientifically proving that these immunological changes actually occurred in the body. It was not until the mid-1920s, that a second significant event occurred.
    Researchers found that, by injecting a minute quantity of purified allergen under the skin, certain individuals would develop a clear skin response; a welt, with or without itching and redness, could be provoked. This positive skin test for allergies would show itself most prominently in patients with hay fever, asthma, chronic rhinitis, hives and eczema. The prick test became a method of demonstrating the involvement of the immune system in allergic reactions. However, the precise biological reason for the reaction continued to remain a mystery.
    It was not until the Sixties, when an important discovery occurred which provided long-awaited scientific support for the classical allergy theory and removed any doubts about the relationship of the immune system with allergies. This breakthrough came about with the scientific discovery of immunoglobulin E (IgE) by a Japanese couple named Ishizaka.
    Classical Allergic Reaction
    The following are the chain of events which happen in allergic reactions:
    An allergen must be present in the body. This allergen is the substance which causes us to have an abnormal immunological response. Allergens tend to be protein molecules. Interestingly enough, the immune system only detects particles of a certain size as potential troublemakers and protein molecules are just the right size. In a small number of cases, the body actually responds to molecules other than proteins. These molecules, which are generally much smaller, are called haptens. By combining with protein molecules, haptens form larger complexes which can then be detected by the immune system. The allergen is detected by the B cells. These are specialized immune cells, capable of producing antibodies. Just like allergens, antibodies are protein molecules, which have the capacity to neutralize allergens. Every B cell produces its own, specific antibody, depending on the type of intruder it needs to respond to. It is easy to understand why the body must have a ready pool of millions of antibodies, in order to combat these numerous offenders. There are five main categories of antibodies (IgG, IgA, IgM, IgD and IgE) which the body releases under different circumstances (for instance to fight off various infections, etc.). In the case of allergies, the body produces the antibody immunoglobulin E (IgE), first discovered by the Ishizakas. Usually, antibodies will bind directly to the appropriate damaging substance and neutralize it. However, IgE deviates from this common path. It first attaches one of its legs to one of the bodys numerous mast cells. The other leg is used to hold on to the offending allergen. This action signals the mast cells to begin disintegrating, thereby releasing histamine. Histamine is a chemical substance responsible for a great number of complaints which may arise during allergic reactions. It causes muscle cramps and an inflammation-like process with redness and swelling of mucous membranes.
    Allergic reactions can occur under a variety of circumstances. For instance, inhaling certain substances, such as grass pollen, house dust, etc., may cause an allergic response. However, the consumption of certain foods may do the same. Allergies typically bring on complaints very rapidly upon contact with the allergen. Complaints may vary from a runny nose, sinusitis, earache or runny eyes to itching of the skin, eczema and shortness of breath.

    Intolerance
    Conventional medicine can easily diagnose and treat allergies for foods or inhalants. Here, the so-called RAST test plays a very important role, because this test can demonstrate the presence of IgE.
    However, demonstrating the presence of intolerance is more difficult. In this situation, similar to the case of classical allergies, the body responds abnormally and, in addition, the immune system does not produce IgE. It quite often takes much longer for complaints to come on, thereby masking the possible link between the offensive substance and the complaints themselves.
    These are only a few of the reasons why food intolerance is considered a fairly controversial concept in conventional medicine. Intolerance can be responsible for a wide variety of complaints which, at first glance, seem to lack a plausible explanation. Intolerance can manifest themselves as the following:
    Gastrointestinal complaints: stomach ache, irritable bowel, Crohns disease, ulcerative colitis Skin complaints: itching, eczema, hives, acne (in adults) Joint and muscle complaints: ranging from atypical pains to rheumatoid arthritis Headache and migraine Chronic fatigue Asthma, chronic rhinitis or sinusitis Pre-menstrual syndrome Hypoglycemia Depression, anxiety Sleeping disorders
    Diagnosing Intolerance
    It is impossible to accurately demonstrate intolerance through conventional testing methods.
    The Amsterdam Clinic currently uses the following test, which is very reliable.
    Another useful test is the IgG(4) antibody test. Here, the presence of IgG(4) antibodies is determined. These antibodies are the slowly occurring variety, which do not appear in the blood until 24 to 48 hours after exposure to an offending food or substance. The reliability of this test varies between 80 and 90%.
    Treatment
    Diet
    In the treatment of inhalant allergies (such as asthma, hay fever) and food allergies and intolerance, avoidance (elimination) of allergens plays an extremely important role. In the case of food sensitivities, either the cytotoxic test or IgG(4) test can help determine reactions to specific foods. Based on the test results, an elimination/rotation diet can be specifically tailored.
    Foods causing strong reactions in these tests, should (temporarily) be excluded from the diet. More moderate reactions allow for rotation of certain food items in the diet. These may be eaten once every four days. Especially during the first week(s) of the diet, withdrawal symptoms, similar to complaints stemming from the cessation of coffee, tobacco or alcohol consumption, may occur. The body seems to crave offending food items. Generally, these withdrawal symptoms disappear after a couple of weeks. Concurrently, those complaints relating to food sensitivity also diminish.
    Using this dietary approach, the reaction to food allergens may decrease in the course of time. After a three month moratorium, reintroduction of forbidden food items can be attempted, one at a time. In this way, food items still causing reactions can be isolated more easily. Often, at least part of existing intolerance completely disappear after an elimination/rotation diet.
    With the treatment for inhalant allergies, elimination is also the first step. It is obvious that patients having an allergy for cats or dogs, should avoid any contact with these pets. The situation becomes more difficult when dealing with allergies to grass or tree pollen, since total elimination is basically impossible. The same goes for house dust mite allergy. The house dust mite lives in mattresses, pillows, carpeting, drapes, upholstery, etc. Through mite-killing pesticides, special mattress and pillow covers, non-carpeted floors, etc. reasonable results can be obtained.
    Medication
    Medicines for inhalant allergies, such as antihistamines (Triludan), corticosteroids (Prednisone, Pulmicort, Becotide), cromoglycates (Lomudal, Lomusol), and airway dilating medication (Ventolin, Berotec, Atrovent) do suppress symptoms, however, they do not cure the allergy! In the realm of conventional medicine, effective medications for food allergy and intolerance do not exist at all.
    Desensitisation
    Enzyme-potentiated desensitisation (EPD) and the provocation/neutralization method are very effective treatments for food allergy/intolerance and inhalant allergy problems. These methods tackle allergy problems at the root.
    During EPD treatment, a small quantity of a food or inhalant allergen mixture is injected intradermally into the skin, in conjunction with the enzyme beta-glucuronidase. This combination causes the body to gradually adjust its exaggerated responses to food and inhalant allergens. In this way, the immune system is readjusted and reset. Initially, the injections have to be given once every two months. Gradually, however, the intervals between injections become longer and the injections can often be discontinued after a time. According to conservative estimates, at least 80% of those patients treated with EPD show considerable improvement in the course of time. Provocation/neutralization can be used both diagnostically and therapeutically. Here, separate extracts of food or inhalants, suspected as possibly offending, are injected intradermally. This causes a welt to appear in the skin. After 10 minutes, the size and nature (firmness, color, etc.) of the welt are evaluated. A positive welt will generally bring on symptoms (provocation). Depending on the size and nature of the welt, as well as, the presence of symptoms, varying concentrations are injected, until a dose is found which does not cause any welt changes or symptoms. This is the neutralizing dose. Injections with the proper neutralizing dose will bring on immediate protection against the symptoms caused by the offending food and/or inhalant. Copyright © 1996 the Amsterdam Klikiek
    For further information please contact:
    Also in THE NETHERLANDS:
    Amsterdam Kliniek
    Reigersbos 100
    1107 ES Amsterdam Z.O.
    Telephone 31 (0)20 697 53 61
    Telefax 31 (0)20 697 53 67
    Lydia S. Boeken M.D. London/Amsterdam

    Scott Adams
    The following is a March 11, 1998 post by Kemp Randolph krand@PIPELINE.COM.
    According to Dr. Hugh Sampson, Mt. Sinai Medical Center, at an AMA sponsored press briefing on Nutrition, in a list of Facts vs. Fictions, Fiction: Skin tests or blood tests can be used to diagnose food sensitivities. Fact: ...A positive test does not mean a person will react to a food...furthermore these tests do not tell whether a person has a non-IgE mediated sensitivity to food.
    He describes these tests only as useful guides and points out that diet testing is the only reliable way to identify a food allergy, preferably where the person does not know whether they have eaten the suspect food.
    Q: If I am sensitive to milk and eggs...could they damage my villi in the same way as gluten?
    A: Theres a specific note in Michael Marshs book about food allergies causing villi damage. Thats the book On Coeliac Disease, page 155. Table there shows that the Type 3 stage of intestinal response, flat destructive does occur with milk, egg, soy and chicken or fish allergies. It differs from the celiac response in that only 1 or 3 of the 5 stages of lesion connected with celiac disease occur with an allergy.
    Whats unclear from this reference and from Medline searches Ive made is whether food allergies in adults cause villi damage. All the references I found were for children. Villi destruction does occur in children with milk allergy, but this like other pediatric allergies, apparently is usually outgrown.

    Jefferson Adams
    Four Big Differences Between Celiac Disease and Non-Celiac Gluten Sensitivity
    Celiac.com 05/08/2015 - While it's true that all people with celiac disease are intolerant to gluten, not all people who are intolerant to gluten have celiac disease.
    Several studies have confirmed the existence of non-celiac gluten sensitivity (NCGS), a hypersensitivity or form of gluten intolerance that causes numerous symptoms similar to those of celiac disease.
    There are several key differences between celiac disease and NCGS. NCGS is distinguished from celiac disease by the following factors:
    No Hereditary Link
    Unlike celiac disease, NCGS is not hereditary, and shows no genetic component.
      No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies.
      No Immumological or Serological Markers
    Researchers have, as yet, identified no immunologic mechanisms or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS.
      Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, and an IgE-mediated allergy to wheat, and by the continued presence of adverse symptoms associated with gluten consumption. Diagnosing celiac disease can be challenging. Misdiagnosis is common, and final and accurate diagnosis can take years and visits to numerous doctors.
    Because of these key differences, non-celiac gluten sensitivity is often even more slippery and difficult to confirm than celiac disease, itself.
    How about you? Do you or someone you know have celiac disease or NCGS? Share your story in our comments section below.
    Source:
    US Pharmacist. 2014;39(12):44-48.

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