WHAT IS NOT COELIAC DISEASE?
NON-COELIAC GLUTEN RELATED DISORDERS
Adverse reactions to food are varied and can often be confused, particularly when involving immune or metabolic components. Common reactions include food allergies, intolerances, and autoimmune processes such as coeliac disease.
Myth buster: "Gluten intolerance" does not exist as an established medical condition. Disorders related to gluten and/or wheat consumption can be categorized mainly into two types:
Autoimmune
Such as Coeliac Disease
Other immune response
Like Gluten Allergy and Non-Coeliac Gluten/Wheat Sensitivity (NCGWS)
Gluten allergy
Food allergies result from inappropriate immune responses to substances generally harmless to most people. Gluten, in this case, acts as an allergen, causing the immune system to produce specific antibodies called immunoglobulin E (IgE).
This triggers immune reactions leading to symptoms such as itching, runny nose, cough, respiratory issues, hives, and swelling of lips or airways immediately after ingestion or contact. In severe cases, it can cause anaphylactic shock, which can be fatal if not promptly treated.
Gluten allergy has a genetic component, so those with immediate family members who suffer from it are more likely to develop it. Although usually identified in early childhood, some allergies can disappear after controlled introduction of the antigen.
However, allergies appearing in adulthood are harder to reverse. Individuals with gluten and/or wheat allergies will test negative for specific antibodies associated with CD.
Forms of wheat-related allergies include food and respiratory allergies, contact urticaria, and wheat-dependent exercise-induced anaphylaxis (WDEIA).
Gluten Sensitivity
Non-Coeliac Gluten/Wheat Sensitivity (NCGWS) is characterized by intestinal and extra-intestinal symptoms related to gluten ingestion. This condition is believed to be mediated by innate immunity, though its pathogenesis remains under investigation.
Patients with NCGWS, similar to those with coeliac disease, improve on a gluten-free diet. However, their tests for coeliac disease are negative; they do not present specific antibodies or intestinal atrophy.
Diagnosing NCGWS is complex due to the lack of specific biomarkers. It is confirmed by excluding coeliac disease, wheat allergy, and other gastrointestinal pathologies, observing symptom improvement on a gluten-free diet, and symptom recurrence upon reintroducing gluten.
The recommended treatment for NCGWS is a strict gluten-free diet for life.
Differentiating Between Disorders
Gluten allergies involve a rapid immune response mediated by IgE antibodies, potentially leading to severe reactions like anaphylaxis. These allergies often appear early in life and have a genetic predisposition, requiring strict avoidance of the allergen and emergency treatment for anaphylactic reactions.
In contrast, NCGWS presents a broader range of symptoms, both intestinal and extra-intestinal. Unlike coeliac disease, NCGWS does not involve an autoimmune response, and patients lack the typical serological or histological markers of coeliac disease.
Diagnosis relies on excluding other causes and observing symptom improvement on a gluten-free diet, which highlights the need for careful medical supervision to avoid misdiagnosis.
Although both gluten allergies and NCGWS involve the immune system, they differ significantly in diagnosis and treatment. Ongoing research aims to better understand these conditions, potentially leading to more accurate diagnostic tools and effective treatments, improving the quality of life for affected individuals.
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