Gluten-Associated Conditions

Gluten-associated diseases have been on the rise in recent years. There are several types of symptoms that patients notice when gluten is consumed. Nevertheless, the question still on the air is: the association of deleterious symptoms that accompanies gluten ingestion is only specific to celiac disease? The answer is no, and here we will explain all about the different organic derangements caused by gluten and their root cause.

Gluten is a mixture of gliadins and glutenins contained in wheat, barley, and rye. Therefore, this complex protein mixture makes it difficult for our digestive enzymes to fully process the compounds, leaving undigested final products on our GI tract. Furthermore, these grains are the main component of wheat-derived and flour products, and they are widely found in common foods consumed around the world.

Several studies have found that the root of gluten’s cytotoxicity is the protein Gliadin. Gliadin provides agglutination activity to gluten-containing grains; it alters redox equilibrium, induces apoptosis, inhibits cell growth, and alters the tight junction’s integrity. The last described effects are presumed to be the cause of the varied symptoms attributed to gluten ingestion.

There are multiple conditions linked to gluten: Wheat allergy, celiac disease, and gluten hypersensitivity; however, their pathophysiology and effects on the patient’s body differ greatly. Here we present the main differences, information that I think is essential for a patient with antecedents for these conditions.

Wheat allergy:

As food allergy, this condition is an immediate IgE mediated reaction that promotes systemic inflammation with the presence of Th2 cytokines expression (i.e., interleukin (IL)-4, IL-13, and IL-5). Hence, this process could be triggered by the ingestion or inhalation of wheat. The symptoms can be portrayed as asthma, allergic rhinitis, gastrointestinal pain, vomiting, atopic dermatitis, watery eyes, urticaria, and exercise-induced anaphylaxis.

Furthermore, the prevalence of wheat allergy in American children is 3%, determined by a skin prick test (SPT). It is believed that most of the children patients outgrow this condition by the age of 12 years old. Conversely, one of the main factors contributing to wheat allergy is the introduction of wheat after 6 months in the weaning process.

Celiac disease:

Celiac disease is considered an immune-mediated enteropathy induced by gluten; this disease affects patients that carry the genotype HLA-DQ2 or HLA-DQ8. Nevertheless, the inflammatory process carried with this disease is mediated by an auto-immune response against tissue transglutaminase. In celiac disease, the exacerbated inflammation reaction and elevated cytokines levels cause cryptal hyperplasia and chronic damage to gastrointestinal microvilli.

It is believed that 40% of individuals carry this genotype, but only 2-3% will develop celiac disease. Some of the signs and symptoms of celiac disease manifest as poor childhood growth, malabsorption causing diarrhea, loss of appetite, abdominal distention, bloating, constipation resulting in weight loss and ultimately affecting children in their longitudinal growth. Likewise, the manifestation of celiac disease can be seen in children’s development and may cause delayed puberty and short stature. In women, there might be an increased risk of miscarriage.

For celiac disease, there are two tests recommended for its diagnosis. Serum IgA antibodies to Tissue transglutaminase and IgG for deaminated gliadin peptides both have good sensitivity and specificity. The genetic HLA-DQ2 and HLA-DQ8 are useful if the serologic tests need further determination. Besides, biopsies are used to determined cellular changes in the GI tract.

Gluten hypersensitivity:

Known also as Nonceliac gluten sensitivity, is a common label to describe a condition caused by intestinal signs and symptoms accompanied by extraintestinal signs and symptoms associated with the ingestion of gluten-containing grains and the later improvement of such symptoms when gluten is taken out of the patient’s diet.

What happens with gluten sensitivity is unknown, and there are no concluding biomarkers that can validate this condition. It has been reported that, besides gluten, wheat amylase-trypsin inhibitors and low-fermentable, poorly absorbed, short-chain carbohydrates can elucidate a better understanding of the root cause of NCGS. The prevalence of NCGS is unknown, but this condition’s self-reported symptoms are more common than celiac disease and wheat allergy.

The avoidance of gluten-containing products joins the medical management of these conditions. Nutritional advice is to be followed. Knowing how to read labels to avoid gluten and introducing cereals to improve fiber content is essential for the patient. There are many factors affecting the prevalence of these conditions and should be taken into account when trying to diagnose a patient.

• Introducing wheat after 6 months of age.
• Having familiar antecedents with allergy or sensitivity to gluten.
• Intestinal permeability, resulting in a temporary reaction.
• Early weaning, not enough breastfeeding.

It may seem that following a gluten-free diet could be difficult and it doesn’t have to be like that.  The food industry provides a great variety of gluten-free products, which are a good choice but we need to watch out for more than 5 ingredients. Fortunately, we can achieve a good diet with the help of alternative foods, the more natural the better.

• Rice in every variation, and its products: rice cakes, rice noodles, rice Krispies, rice cereal.
• Potatoes.
• Sweet potato.
• and if you are not avoiding corn, you can have popcorn, a tortilla in all its variations.
• Products derived from lentils and beans.
• Quinoa.
• Certified gluten-free oats (watch out for reactions).
• Amaranth.

I hope this information provides you with a new insight and if you are feeling some of these symptoms after eating gluten, reach out to your Doctor. You can be sure that he will perform the right tests for your diagnosis and ensure the best treatment for you. Lastly, the dietary changes might seem much, but now you know that alternatives are right on the tip of your fingers and they are tasty too.- Ana Paola Rodríguez Arciniega. MS

Leonard, Maureen M., et al. “Celiac disease and nonceliac gluten sensitivity: a review.” Jama 318.7 (2017): 647-656.

Zellweger, Fabian, and Alexander Eggel. “IgE‐associated allergic disorders: recent advances in etiology, diagnosis, and treatment.” Allergy 71.12 (2016): 1652-1661.

Cianferoni, Antonella. “Wheat allergy: diagnosis and management.” Journal of Asthma and Allergy 9 (2016): 13.

Catassi, Carlo, and Alessio Fasano. “Celiac disease.” Gluten-free cereal products and beverages. Academic Press, 2008. 1-I.