Very often it is thought that the only disease related to gluten is coeliac disease, but there are other similar diseases: gluten sensitivity and allergy to wheat.
It is helpful to make distinctions in order to treat each disorder properly. So here is an introduction to these three conditions.
Coeliac disease
According to the Department of Health, coeliac disease is:
"a permanent inflammatory-based disease of the small intestine, characterized by the destruction of the mucosa of this intestinal tract. It is caused by an autoimmune reaction to gluten, the protein alcohol-soluble fraction of some cereals such as wheat, barley, rye, dinkel wheat, kamut, spelt and triticale.
So coeliac disease is in fact a disease:
- genetic, meaning nothing can be done to prevent it
- chronic, that is it will remain for life
There is no cure, but there is a remedy: avoiding the intake of foods that contain gluten.
Coeliac disease affects 1% of the population. Also according to the Italian Department of Health, “the theoretical number of coeliacs is around 600,000 compared to 198,427 diagnosed to date" (2016 data).
The symptoms are various, typically gastrointestinal disorders such as abdominal pain, diarrhea, bloating, vomiting, but also chronic fatigue, growth disorders, alopecia, anemia, dermatitis...
How to detect it?
To ascertain this autoimmune disorder there are two steps:
- serological test (blood sampling) to look for specific antibodies that signal the disease
- afterwards it is performed an intestinal autopsy, that is, a sampling of a small fragment of the intestinal mucosa to see if the cells affected by coeliac disease are damaged.
Gluten sensitivity
Gluten sensitivity (sometimes called gluten or wheat intolerance) is a recently introduced word for a disorder that presents symptoms similar to those of coeliac disease, but it gives negative results when tested for it.
The symptoms are therefore the same for both disorders, although lighter in this case (mainly intestinal problems, fatigue, migraines), still it is not coeliac disease.
It is not yet understood how this disorder works and what causes it, but it has been observed that, just as with coeliac disease, gluten sensitivity symptoms stop when gluten is no longer consumed.
Since the causes of the disease are yot not clear, it is not possible to pinpoint it with certainty: it is simply a process of elimination.
If the tests for coeliac disease are negative, but the symptoms disappear when you stop consuming gluten for a fairly prolonged period of time (about 6 weeks), it is assumed that you are dealing with gluten sensitivity and therefore it must be finalized a diet with an expert to exclude the substances that give you problems.
Wheat allergy
As with any other allergy, the body of the patient produces antibodies against certain components of wheat (not just gluten).
In contrast to coeliac disease, it is triggered not only by the intake of wheat as food, but also by inhalation through the respiratory tract or skin contact.
Symptoms can occur immediately or even within a few days, and in addition to the typical symptoms of any allergy (difficulty breathing, burning and itching of the mouth, nose, eyes, throat or skin) there are also symptoms that can be confused with those of coeliac disease (nausea, vomiting, diarrhea).
There are various ways of diagnosing this illness:
- blood analysis to look for the IgE antibodies responsible for the problem
- skin test (prick test)
- oral food challenge test (it requires the patient to eat the suspected food in gradually increasing amounts under controlled conditions)
Again, the solution is to eliminate wheat from the diet (under the guidance of a dietician), as a matter of fact some foods that are harmful to coeliacs are not harmful to wheat allergy sufferers (e.g. rye and barley), because although they contain gluten they do not trigger the allergic reaction.
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