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Gluten allergy can affect both children and adults. It turns out that up to 10% of the population gluten can activate the immune system, causing various forms of gluten intolerance (hypersensitivity) to gluten, commonly known as gluten allergies. What shows that you are allergic to gluten? What are the symptoms of a gluten allergy?

Gluten allergyoccurs as a result of an abnormal immune system response to gluten. Gluten is a cereal protein found in many foods.Symptoms of gluten allergymay or may not appear only in childhood. Sometimes a gluten allergy occurs much later - in adults.

Gluten allergy - what is gluten?

Gluten is a mixture of various proteins, mainly gliadin and glutein, found in wheat (Triticum aestivum) and other grains such as rye (Secale cereale) and barley (Hordeum vulgare). In the case of rye and barley, the gluten proteins are called secalin and hordeine respectively.

Gluten is one of the most widely used food ingredients in the industry due to its unique technological and organoleptic properties. It makes the bread sticky, flexible and cohesive, ensuring that the baked goods have the right texture and flavor. Hence, its presence in various food products is common.

Gluten, due to the high content of the amino acids glutamine and proline, is a protein that is difficult to digest by the digestive tract, which can activate our immune system.

The symptoms of gluten allergy are mainly caused by gliadins, which can be divided into α-gliadins, β-gliadins, γ-gliadins and ω-gliadins. The fragment of gliadin that probably most strongly activates the immune system is the fragment 57-89 of α-gliadin, the so-called 33-Mer peptide.

Gluten allergy - types

Gluten allergy (also known as intolerance or hypersensitivity) results from an abnormal immune system response to gluten. The allergic reaction to gluten includes both the mechanisms mediated by IgE antibodies (IgE-mediated reactions) and reactions without them (IgE-independent reactions). We currently distinguish three types of gluten allergy:

  • IgE-dependent reactionswhich cover a wide rangeimmune reactions to various wheat proteins, e.g. gluten, trypsin and amylase inhibitors, albumin. In a narrower sense, gluten allergy is distinguished. The most common gluten allergy is caused by a protein fraction called ω-5-gliadin. These reactions produce IgE antibodies to gliadin that activate mast cells and basophils. Allergy to wheat proteins, including gluten, occurs in 2-9% of children and in 0.5-3% of adults.
  • IgE-independent reactions , which include, among others celiac disease. Celiac disease is an autoimmune disease in which genetic predisposition plays an important role. In celiac disease, there is an abnormal lymphocyte response that produces IgG and IgA antibodies against gluten proteins (gliadin) and against its own tissues (the enzyme tissue transglutaminase, endomysium). The consequence is chronic inflammation in the intestinal mucosa and the disappearance of intestinal villi. The prevalence of celiac disease is estimated at around 0.5% -1% in the general population.
  • Non-celiac gluten hypersensitivity , is a type of gluten allergy that has been described relatively recently and its pathomechanism is not fully known. Possibly non-celiac gluten sensitivity is caused by IgE-independent reactions. Contrary to celiac disease, there is no damage to the mucosa and no atrophy of the intestinal villi. The incidence of non-celiac gluten intolerance ranges between 0.16% and 13%.

Gluten allergy - symptoms

Symptoms of gluten allergy and the time of its appearance depend on its clinical presentation. IgE-mediated reactions are characterized by a very rapid onset of symptoms (seconds-minutes) from exposure to gluten or other wheat proteins and include:

  • diarrhea
  • flatulence
  • vomiting
  • swelling of the airways
  • shortness of breath
  • hives
  • atopic dermatitis
  • itching
  • anaphylactic shock

Symptoms of IgE-independent reactions, e.g. celiac disease, may appear weeks-years after exposure to gluten. It is worth emphasizing that the latent form of celiac disease is quite common and for many times it does not give any specific symptoms.

It is also wrong to believe that if the disease does not appear in childhood, it will not threaten us in adulthood. Currently, more and more cases of celiac disease are diagnosed in adults.

The symptoms of non-celiac gluten intolerance appear a few days-weeks after contact with gluten.

The symptoms of celiac disease and non-celiac gluten intolerance can be similar and include:

  • stomach pains
  • flatulence
  • diarrhea
  • vomiting
  • vitamin and mineral deficiencies due to malabsorption disorders (more common in celiac disease)
  • anemia
  • weight loss or stunted growth in children
  • headaches
  • depression
  • chronic fatigue
  • muscle weakness
  • imbalance and coordination disorders (also known as gluten ataxia)
  • fertility disorders
  • osteoporosis
  • arthritis
  • skin problems (celiac disease is called dermatitis herpetiformis or Duhring's disease).

Gluten allergy - how to diagnose?

There is no single test that can identify or rule out all types of gluten allergies. In addition to the tests themselves, the patient's carefully interviewed interview with the patient plays a key role.

In the diagnosis of IgE-mediated reactions, determination of food-specific IgE in the blood (sIgE), prick tests and patch tests are used. If any of the above tests are positive and symptoms are present at the same time, it is a confirmation of a gluten allergy.

In the case of celiac disease diagnostics, in addition to the interview, the following are important:

  • genetic tests that examine the genes encoding the HLA-DQ2 and DQ8 proteins for variants predisposing to celiac disease (their presence is found in 98-99% of patients)
  • serological tests where the concentration of IgG and IgA antibodies to transglutaminase 2 (anti-tTG2) is performed with the simultaneous measurement of total serum IgA
  • histopathological tests in which a section of the intestine is assessed for histological changes according to the Marsh scale; this test still remains the "gold standard" in diagnosis, allowing the confirmation of celiac disease

The most diagnostic problems are associated with the diagnosis of non-celiac gluten intolerance, as there are currently no diagnostic markers for this disease entity. Therefore, its diagnosis is based on the exclusion of celiac disease and IgE-dependent allergies, followed by the elimination of gluten for at least 6 weeks and monitoring of the patient's symptoms.

Gluten allergy - treatment

People diagnosed with gluten allergy should avoid this protein in their diet and follow a gluten-free diet. In the case of IgE-mediated reactions, antihistamines and corticosteroids are additionally used.

Gluten is found in wheat, rye and barley and all varieties of these grains. A controversial cereal for the form of gluten that can cause symptomspeople with gluten allergies are oats. Therefore, it is best to consume the so-called certified oats.

  • Gluten intolerance - symptoms, tests, diet
  • Genetic testing for celiac disease
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Author: Time S.A

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Find out moreAbout the authorKarolina Karabin, MD, PhD, molecular biologist, laboratory diagnostician, Cambridge Diagnostics Polska A biologist by profession, specializing in microbiology, and a laboratory diagnostician with over 10 years of experience in laboratory work. A graduate of the College of Molecular Medicine and a member of the Polish Society of Human Genetics. Head of research grants at the Laboratory of Molecular Diagnostics at the Department of Hematology, Oncology and Internal Diseases of the Medical University of Warsaw. She defended the title of doctor of medical sciences in the field of medical biology at the 1st Faculty of Medicine of the Medical University of Warsaw. Author of many scientific and popular science works in the field of laboratory diagnostics, molecular biology and nutrition. On a daily basis, as a specialist in the field of laboratory diagnostics, he runs the content department at Cambridge Diagnostics Polska and cooperates with a team of nutritionists at the CD Dietary Clinic. He shares his practical knowledge on diagnostics and diet therapy of diseases with specialists at conferences, training sessions, and in magazines and websites. She is particularly interested in the influence of modern lifestyle on molecular processes in the body.

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