Gluten Intolerance, Celiac Disease And Gluten Allergy - Are They The Same Thing?

Gluten is a mixture of two proteins - gliadin and glutenin, which are found in almost all plant seeds. It has been found that up to half of the world's population suffers from hypersensitivity to gluten in a specific subgroup of grains - wheat, rye, barley and oats. In this sense, the gluten diet does not exclude all cereals, but only those that belong to the family of cereals.

Gluten intolerance and celiac disease are diseases with similar or even identical symptoms, which makes the differentiation of the disease impossible without a clinical test. The two diseases differ in the type of reaction to gluten. Gluten allergy is an anaphylactoid reaction and differs from the other two conditions with the characteristic symptoms of the first type of allergic reaction.

Celiac disease is an autoimmune disease with a frequency of about 1%, in which the immune system reacts to gluten by attacking its own small intestinal hairs (villi intestinales), which leads to disruption of the structure of the mucosa in the small intestine and villous atrophy. This is the reason for the development of malabsorption syndrome and osteoporosis, and in some cases even carcinogenesis.

The autoimmune nature of the disease means that gluten itself does not have a direct damaging effect on the mucosa, but stimulates the immune system to an atypical response. As an autoimmune disease, celiac disease is hereditary and is triggered by certain external factors (stress, trauma, infections, etc.)

Gluten intolerance differs from celiac disease in the type of response of the immune system - this is an immune response other than the autoimmune response and different from the typical IgE-mediated allergic reaction. The immune system responds to gluten as a foreign body with an inflammatory response, but without erosive changes in the mucosa. However, it is not entirely clear whether gluten intolerance can lead to autoimmune responses and mucosal changes over long periods of time. There is still controversy in the scientific community about the existence and pathogenesis of gluten intolerance. There are no biochemical markers for the pathology and the only way to make a diagnosis is after exclusion of celiac disease and gluten allergy as differential diagnoses and improvement in general condition after exclusion of gluten from the diet.

Gluten allergy is an allergic reaction of the first type (anaphylaxis), which is due to massive mast cell degranulation and secretion of large amounts of IgE antibodies - symptoms include life-threatening bronchospasm, edema, abdominal pain and diarrhea, hypotension, urticaria and others.

Symptoms characteristic of celiac disease and gluten intolerance include:

• Swelling and flatulence, which are often the cause of heart palpitations - the increased amount of gas in the gastrointestinal tract leads to the so-called. gastro-cardiac syndrome, in which the stimulation of the vagus nerve causes bradycardia followed by reflex tachycardia, extrasystoles, etc .;
• Colic;
• Chronic diarrhea or constipation;
• Whitish feces with altered pungent odor;
• Nausea and vomiting;
• Headache;
• Fatigue and inability to concentrate;
• Anxiety and depression;
• Development of malabsorbent syndrome (celiac disease) - weight loss and appetite, anemia (most often due to iron malabsorption), osteoporosis and / or osteomalacia, developmental delay, muscle atrophy, late puberty, etc .;
• Herpetiform dermatitis (in celiac disease) - a very itchy rash with the formation of vesicles;
• Infertility and miscarriages (in celiac disease) - due to malabsorption of vitamin D and calcium and others.

The diagnosis is made by serological testing for gluten antibodies, as an important condition is that it be performed before starting a diet; fibrogastroscopy with biopsy. With a negative serological test, this does not mean a definitive rejection of gluten sensitivity - it is necessary to adhere to a gluten-free diet and monitor symptoms. If it goes away, it's probably gluten intolerance.

The treatment is carried out through a lifelong gluten-free diet - exclusion of wheat-derived foods, as well as secondary treatment with appropriate supplementation (vitamin D, zinc, iron, calcium, etc.).

It is important to perform a secondary fibrogastroscopy with a biopsy after at least 6 months to monitor the condition of the mucosa and ganglia.

In conclusion, gluten sensitivity is a heterogeneous group of diseases (celiac disease, gluten intolerance and gluten allergy) that have different pathogenesis but similar symptoms (except for gluten allergy). All three conditions require a lifelong gluten-free diet.