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Gluten intolerance can cause skin symptoms such as a rash. However, in both children and adults, this symptom may appear in the course of many diseases. Therefore, when gluten intolerance is suspected, tests should be performed that will ultimately confirm the diagnosis. Then a proper diet is necessary - this is the only form of treatment of gluten intolerance. What are the symptoms of gluten intolerance? What tests should be performed? What can you eat if you are gluten intolerant? Are gluten intolerance and celiac disease the same?

Contents:

  1. Gluten intolerance - celiac disease and more
  2. Gluten intolerance - symptoms
  3. Gluten intolerance - research
  4. Gluten intolerance - diet

Gluten intoleranceis an increasingly common problem. It is estimated that up to 10% of the population may be intolerant to gluten - a protein found in cereals such as wheat, rye and barley (in fact, gluten is a mixture of various proteins, mainly gliadin and glutein, and the symptoms of gluten intolerance are mainly caused by gliadin) .

Recently, many myths about gluten and its harmfulness to he alth have accumulated. The consequence of this is the fashion for the elimination of gluten from the diet without prior diagnosis and medical indications.

So far, three diseases related to gluten intolerance have been described:

  • celiac disease
  • wheat allergy
  • non-celiac gluten sensitivity

Gluten intolerance - celiac disease and more

1.Celiac disease

Celiac disease (also known as celiac disease) is a gluten-induced autoimmune disease.

People with celiac disease also carry specific genetic alterations (HLA-DQ2 and HLA-DQ8 histocompatibility gene polymorphisms) that predispose their immune systems to recognize gluten as foreign.

This then activates T cells, B cells (which produce antibodies) and causes chronic inflammation. As a consequence, histopathological changes in the intestinal mucosa are characteristic for patients with celiac disease.

IgG and IgA antibodies are produced against gluten proteins (specifically gliadin) andagainst your own tissues (the enzyme tissue transglutaminase). Their determination in blood is a key element of the laboratory diagnosis of celiac disease.

Celiac disease affects 1 in 3,345 people, but considering that the disease can be in a latent form, without any symptoms, it is estimated that this can occur in up to 1 in 100-300 people.

It should also be emphasized that it is incorrect to believe that if the disease does not appear in childhood, it will not threaten us in adulthood. Currently, all over the world there is an increase in the incidence of celiac disease in the group of adults.

2.Wheat allergy

Wheat allergy, like celiac disease, is an immune-mediated reaction. However, in the case of wheat allergy, it produces antibodies that are characteristic of allergic diseases, i.e. IgE.

Allergy to wheat proteins, including gluten, occurs in 2-9% of children and in 0.5-3% of adults. What distinguishes wheat protein allergies from other gluten intolerances is that symptoms appear seconds, minutes after contact with gluten.

3.Non-celiac gluten sensitivity (NNG)

Non-celiac gluten sensitivity (NCGS) is a relatively recent disease associated with gluten intolerance.

The symptoms of NCGS are similar to those of celiac disease, but occur faster hours-days after consuming gluten. Contrary to celiac disease, no mucosal damage is found in intestinal biopsy.

Worth knowing

Wheat allergy and gluten allergy

Wheat allergy is a reaction of the immune system to proteins contained in this grain, eg trypsin and amylase inhibitors, albumin. In a narrower sense, we are talking about an allergy to gluten, which is specifically to one protein that is found in wheat.

Therefore, a gluten allergy is a type of wheat allergy. Gluten is a mixture of proteins found in wheat grains, mainly gliadin and glutein, which make up 80% of all wheat proteins.

Gluten allergies are most often caused by a protein fraction called omega-5-gliadin. In order to identify the protein responsible for the symptoms of wheat allergy, the concentration of specific IgE in the blood should be tested.

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Gluten intolerance - symptoms

Symptoms of gluten intolerancemay vary depending on the type of disease involved. In wheat allergy, symptoms appear very quickly (seconds, minutes after eating wheat) and include:

  • digestive system (diarrhea, flatulence, vomiting)
  • respiratory system (swelling of the respiratory tract, shortness of breath)
  • skin (urticaria, atopic dermatitis, itching)
  • in rare cases, an allergy can lead to anaphylactic shock which may be life-threatening

The symptoms of celiac disease and NCGS are very similar and include:

  • stomach pains
  • flatulence
  • diarrhea

It is also worth emphasizing that in people with NCGS, symptoms appear hours-days after exposure to gluten. However, in celiac disease, this period is much longer and amounts to weeks or even years from the consumption of gluten.

  • nausea and 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 herpetic dermatitis or Duhring's disease)
  • insomnia

Gluten intolerance - research

The diagnosis of gluten-dependent diseases is not simple due to the multi-organ manifestation of the disease and complex pathomechanisms.

Wheat allergy is the least common, but the diagnosis of this disease is quite simple due to the speed of the onset of symptoms after contact with gluten or other wheat proteins.

In the laboratory diagnosis of allergy, the determination of food-specific IgE in the blood (sIgE), prick tests and patch tests are used.

Although there is no single test that unequivocally confirms or excludes celiac disease, its diagnosis includes:

  • genetic tests, where genes encoding HLA-DQ2 and DQ8 histocompatibility proteins are examined for variants predisposing to celiac disease. Their presence is found in 98-99% of patients, but it must be borne in mind that 30-40% of he althy people also have risky HLA-DQ2 and DQ8 variants, and yet the disease does not have to occur innever develop them, as environmental factors play a significant role in the development of celiac disease. Genetic testing can possibly rule out celiac disease
  • serological tests - the currently recommended test by ESPGHAN (European Society for Pediatric Gastroenterology, Hepatology and Nutrition) is the determination of the concentration of IgG and IgA antibodies against transglutaminase 2 (anti-tTG2) with simultaneous measurement of total IgA in the serum, in order to exclude its shortages. The anti-tTG2 antibody test has a high sensitivity and specificity, therefore this test should be used as a screening test
  • histopathological examinations - involves the assessment of a section of the intestine in terms of histological changes according to the Marsh scale. Type 2 or 3 lesions confirm celiac disease. These tests are still the "gold standard" in diagnosis, allowing the confirmation of celiac disease

Please note that the production of antibodies in celiac disease is dependent on gluten intake, so if someone is on a gluten-free diet, serological tests may be false negative.

Similar results can be obtained in people taking medications that reduce immunity. Celiac disease should also be differentiated from other diseases of the digestive system, such as irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD).

The most diagnostic problems are associated with the diagnosis of NCGS, as there are currently no specific diagnostic markers for this disease. Therefore, the diagnosis of NCGS is based primarily on the exclusion of celiac disease and wheat allergy.

After these diseases have been ruled out, provocation tests are applied to the patient. After gluten has been eliminated for at least 6 weeks, the patient's symptoms are monitored and if the patient does not respond to a gluten-free diet, NCGS is ruled out.

Worth knowing

Gluten intolerance and Duhring's disease

A specific manifestation of celiac disease is herpetic dermatitis, i.e. Duhring's disease. Gastrointestinal symptoms rarely occur in people with this disease, despite the presence of changes in the intestinal mucosa on the histopathological examination.

The cause of the disease is gluten, which triggers the body's immune response and causes the deposition of IgA autoantibodies in the skin. A symptom of Duhring's disease is the presence of vesicular, itchy lesions filled with serous fluid. The lesions are most often located on the elbows, knees and buttocks.

Duhring's disease is relatively rare and is most common in the Nordic countries (approximately 20 cases per 100,000 inhabitants). It can appear at any age, but most oftenoccurs in people between 15 and 40 years of age.

Gluten intolerance - diet

If there is any gluten intolerance, the only "treatment" method is to eliminate it from the diet. Gluten is found in wheat, rye and barley and all varieties of these grains.

A controversial grain of gluten that can cause symptoms in people intolerant to gluten is oats. Therefore, it is best to consume the so-called certified oats.

Gluten can be found in many non-grain products. It is added to foods such as cold cuts, canned meat and fish, yoghurts, processed cheese and cream.

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To be sure that a given product does not contain gluten, look for products with the so-called crossed ear. However, you need to remember that usually gluten-free finished products are highly processed, contain unhe althy palm oil, preservatives and raising agents, and little dietary fiber.

There is a large group of "naturally" gluten-free grains that are rich in nutrients and fiber. These include, among others :

  • rice
  • buckwheat
  • amarantus
  • quinoa
  • millet (millet)

If you have been diagnosed with any gluten-dependent disease, it is best to contact a qualified nutritional advisor who will help you compose a he althy and balanced gluten-free diet.

See the gallery of 5 photosWorth knowing

Is gluten harmful to he alth and is it worth eliminating?

Gluten contains large amounts of the amino acids glutamine and proline, which makes it very resistant to digestion by gastric juice and digestive enzymes.

Incomplete digestion of gluten by the body makes it a protein that can over-activate the immune (immunogenic) system.

Several proteins found in gluten that have the ability to activate the immune system have been described, and the fragment 57-89 of α-gliadin, the so-called 33-Mer peptide.

Even so, there are no scientific studies that indicate that gluten is harmful to everyone and should be eliminated from the diet. So far, three diseases related to gluten intolerance have been described: celiac disease, wheat allergy and non-celiac gluten sensitivity. And these are the only medical indications for a gluten-free diet.

Unfortunately, many people choose to eliminate gluten-containing products in order tolead a "he althy lifestyle" without proper diagnostics.

Not knowing, however, that the elimination of gluten products without consulting a specialist may lead to vitamin and mineral deficiencies.

Recent studies indicate that an improperly composed gluten-free diet may also adversely affect the microbiological balance of the gastrointestinal tract, possibly as a result of an insufficient supply of dietary fiber.

References:

1. Karabin K. Diagnostics of gluten-dependent diseases "Contemporary Nutritionist" 16/20182. Internal diseases, edited by Szczeklik A., Medycyna Praktyczna Kraków 2005.3. Leonard M. M. et al. Celiac Disease and Nonceliac Gluten Sensitivity: A Review. "JAMA" 2022, 15, 318 (7), 647-656.4. Husby S et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. "J Pediatr Gastroenterol Nutr." 2012, 54 (1), 136-60.5. Elli L. Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity. "World J Gastroenterol." 2015, 21, 21 (23), 71106. Igbinedion S.O. et al. Non-celiac gluten sensitivity: All wheat attack is not celiac. "World J Gastroenterol." 2022, 28, 23 (40), 7201-7210.

About 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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Gastrology