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Gluten free diets have become quite trendy as a healthier lifestyle or are undertaken due to digestive problems with common cereal grains. However, many people on the gluten-free bandwagon don’t know much about gluten, or why, precisely, they should avoid it. Wheat allergy and celiac disease are also common food allergies and tend to be used interchangeably with gluten sensitivity. However, they are all quite different types of adverse food reactions. Let’s try and clear up some of the confusion.

In general, wheat allergy occurs in young children where they develop an allergic antibody called IgE against wheat proteins that are different from the gluten protein. They will usually be able to tolerate other grains such as rye, barley and oats just fine. If they consume wheat products, however, symptoms are usually immediate and commonly include vomiting, rash and swelling. Although reactions of this type to wheat are usually not life threatening, carrying auto-injectable epinephrine is strongly recommended as a precaution against a severe allergic reaction which may be accompanied by difficulty breathing. The good news is that IgE-mediated wheat allergy is usually outgrown in kids by 3-5 years of age and developing wheat allergy as an adult is uncommon.

Gluten is one of many specific types of proteins in wheat but also occurs in other grains such as rye and barley. Oats do not contain gluten and are generally safe in gluten sensitive individuals but cross-contamination by other grains in oat products should be considered. An allergy or sensitivity to gluten is usually caused by a more complex immune reaction and tends to be delayed in onset as opposed to the immediate reaction seen with wheat allergy. This type of allergic reaction may occur several hours after gluten exposure and results in chronic symptoms which are concentrated in your gut; such as belly pain and persistent diarrhea. Strictly avoiding gluten usually results in rapid improvement, usually within a few weeks of undertaking a gluten-free diet.

Celiac disease is essentially an autoimmune disease and severe form of gluten allergy where you make antibodies against your own gut tissue This leads to damage of the small intestinal lining and over time prevents it from absorbing some nutrients (malabsorption). Symptoms may include chronic watery diarrhea, fatigue, weight loss, bloating and anemia. An itchy rash of bumps and blisters known as dermatitis herpetiformis may develop as well. In children, malabsorption can affect growth and development. This is why its so important to diagnose celiac disease right away through lab testing looking for those attacking autoantibodies and having a gastroenterologist visualize the small intestine by endoscopy. Again, strict gluten avoidance in the diet usually results in rapid improvement.

Last but not least, some people who feel better on a gluten-free diet, may actually be sensitive to a specific kind of sugar in the wheat and not the gluten protein at all ! That carbohydrate, called fructan, may irritate the gut causing gas, diarrhea, distention and other uncomfortable symptoms. It’s part of other dietary sugars present in many foods, called fermentable oligo/ di-mono-saccharides and polyols, or FODMAPs as a short acronym. The condition they trigger is commonly known as irritable bowel syndrome. A low FODMAP diet is recommended for these patients and it has worked quite well in some small studies.

There have been many more cases of food allergies to grains in our diet over the last several years as allergies in general are on the rise. So if you feel you may have an allergy to wheat or gluten, or maybe even irritable bowel syndrome, make sure to have a prompt evaluation by a board certified allergist. Bon Appetit !

Dr. Shaz Siddiqi, M.D.