Comparing Wheat Allergy and Celiac Disease

What Allergy vs. Celiac Disease Male: There’s a little confusion about celiac disease, wheat allergy, gluten as an allergen as opposed to being something called a celiac disease, can you undo the confusion of the different terms that sometimes used simultaneously by people? Michael Marcus: Certainly. There are several different types of intolerances to wheat and wheat-containing products like bread, cake and pasta. Wheat as we know is a grain that grows and it has several different proteins. Other’s protein is gluten. It seems to be the most important protein when it comes to abnormal immune responses but there are really two very different types of immune responses to gluten. A true allergy is an immune response based on the production of a protein called IgE. When IgE is produced by an allergic person and that is specified against the gluten protein of wheat, that IgE will trigger what’s called an immediate reaction. That immediate allergic reaction will include runny rose, watery eyes. It could include a rash like hives. It could even include wheezing or asthma symptoms. Occasionally, it could include intestinal symptoms, bellyache, some nausea, some bloating; some feelings of discomfort in the belly and occasionally diarrhea but those are much less common. Those reactions usually occur within a half an hour of taking in the wheat protein. Occasionally, we can also have a delayed reaction where it might occur six to 12 hours after taking in the wheat protein. That is very specifically an IgE allergy. The other form of abnormal immune response to gluten is based on a different protein in the immune system, IgG. IgG reaction will lead to a disease called celiac disease or gluten enteropathy. In this disease, what occurs after eating wheat-containing products, you’ll see an inflammation of the intestinal tract that get progressively worse and worse and worse overtime. You do not get runny nose, watery eyes and other kinds of classic allergy symptoms. You only get the intestinal symptoms and the symptoms get progressively worse. If you do a biopsy of the intestines, you see a very severe inflammatory reaction and that reaction leads to significant belly pain, significant diarrhea and very poor appetite. You can have weight loss. You’ll feel tired. You’ll feel sick and very, very uncomfortable and that is because it’s a very different portion of the immune system that’s being affected. In patients who have gluten enteropathy, the only treatment is to avoid eating wheat and wheat-containing products. You have to go on what’s called the gluten-free diet. By doing that, the inflammation in the intestines get progressively better, the intestines heal and you can have an otherwise normal life avoiding wheat. In patients who have wheat allergy which is IgE-Mediated, you also need to avoid all wheat products. The difference is that with IgE-Mediated wheat allergy, most patients outgrow that. So, by taking off wheat for several years, it allows the allergic reaction to fade and many times the patient can then be exposed and eat wheat in controlled fashion without having those symptoms come back. In gluten enteropathy, we do not outgrow that problem and avoiding wheat becomes a lifelong challenge. Michael Marcus, MD Director Pediatric Allergy & Pulmonary – Maimonides Medical Center Fellowship: Children’s Hospital of Philadelphia Castle Connolly Top Doctor DrMDK.com