Non-Celiac Gluten Sensitivity and Wheat Allergy Sometimes Mistaken for Celiac Disease

Celiac.com 10/25/2023 - Imagine eating a slice of your favorite bread and soon feeling unwell. Your stomach churns, you're tired, and maybe you even vomit, or break out in a rash. These symptoms can sometimes last for days or weeks afterward. What could be causing these symptoms? They might be related to gluten, a protein found in wheat, rye, and barley. 

But before you jump to conclusions, it's crucial to understand the differences between three conditions that share some similarities: celiac disease, non-celiac gluten sensitivity (NCGS), and wheat allergy.

What is Celiac Disease?

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What it is: Celiac disease is an autoimmune disorder that primarily affects the small intestine. It's a lifelong condition that occurs when individuals with celiac disease consume gluten—a protein found in wheat, barley, and rye—and their immune system reacts by damaging the lining of the small intestine. This damage impairs the absorption of nutrients from food and can lead to a wide range of symptoms and long-term health complications.

Symptoms: These can be diverse, ranging from gastrointestinal issues like diarrhea and abdominal pain to non-gastrointestinal problems such as chronic headaches and certain rashes. Some individuals with celiac disease may not exhibit any symptoms. Also, celiac disease is commonly mistaken for numerous other conditions.

What sets it apart: Complete gluten avoidance is essential, along with meticulous efforts to prevent cross-contamination. Since it can run in families, screening for celiac disease is vital among relatives. It can develop at any age, so both pediatric and adult doctors can provide care.

Treatment: Lifelong adherence to a gluten-free diet and regular follow-up care. Dietitians and healthcare providers guide patients in food choices, label reading, and lifestyle adjustments.

Non-Celiac Gluten Sensitivity (NCGS)

What it is: NCGS involves gastrointestinal and non-gastrointestinal problems triggered by gluten consumption. However, blood tests and biopsies for celiac disease may be negative.

Symptoms: Similar to celiac disease, including abdominal pain, bloating, and fatigue.

What sets it apart:  There are some differences between celiac disease and NCGS:

• No Hereditary Link - Unlike celiac disease, NCGS is not hereditary, and shows no genetic component.
• Not an Autoimmune Disorder: NCGS is not an autoimmune disorder. Unlike celiac disease, it does not involve an autoimmune response or the production of specific antibodies.
• Symptoms Without Autoimmune Damage: Individuals with NCGS experience symptoms (such as gastrointestinal discomfort, fatigue, headaches) when they consume gluten, but these symptoms are not accompanied by the autoimmune damage seen in celiac disease.
• Diagnosis by Exclusion: NCGS is diagnosed by excluding celiac disease and wheat allergy through specific testing. There are no specific biomarkers for NCGS.
• Variable Sensitivity: Sensitivity to gluten in NCGS can vary widely between individuals, and the exact mechanisms underlying NCGS are still not fully understood.

People with NCGS may be able to tolerate some gluten, up to the threshold causing symptoms. The restrictions and precautions regarding gluten and cross-contamination are less strict compared to celiac disease.

Treatment: Despite negative celiac tests, patients with NCGS experience symptoms. Healthcare providers determine the amount of gluten causing symptoms and help eliminate it from the diet. Symptoms generally improve on a gluten-free diet, but consulting a dietitian is crucial to prevent vitamin and nutritional deficiencies.

What is Wheat Allergy?

What it is: Wheat allergy is an allergic response that involves the immune system, specifically IgE antibodies. When an individual with a wheat allergy consumes wheat proteins, their immune system perceives these proteins as harmful invaders and triggers an allergic reaction.

Symptoms: Symptoms of a wheat allergy can vary in severity and may include hives, difficulty breathing, digestive problems, and, in severe cases, anaphylaxis, a potentially life-threatening reaction that requires immediate medical attention.

What sets it apart: The primary treatment for a wheat allergy is strict avoidance of wheat and wheat-containing products. Individuals with a wheat allergy need to be vigilant about reading food labels, as wheat can be found in unexpected places, like sauces, soups, and processed foods. Wheat allergy is the only gluten-related condition where EpiPens (injectable epinephrine) may be used to stop severe allergic reactions. Allergists, rather than gastrointestinal doctors, provide diagnosis and treatment.

Treatment: Strict avoidance of wheat and wheat-containing products. In case of an allergic reaction, an EpiPen may be used. Dietitians can assist in removing problematic gluten from the diet.

In summary, while these conditions share some common features, understanding the differences is essential for accurate diagnosis and appropriate management. 

If you suspect you have one of these conditions, it's important to consult a healthcare professional for proper evaluation and guidance. Remember, self-diagnosis can be risky, and unreliable, so seek expert advice for the best diagnosis, treatment, and outcome.