Gluten sensitivity, not celiac disease

Wheat proteins can trigger very different reactions in the body. A correct diagnosis allows you to intervene in the most appropriate way to solve the problem without interfering with the quality of life.

The landscape of diseases associated with gluten intolerance is enriched by a new disorder: gluten sensitivity.

According to initial estimates, it affects 6 percent of the Italian population and differs from celiac disease and wheat allergy, especially with regard to the timing of onset: it can increase or disappear without leaving any consequences.

The diagnosis occurs mainly in adult individuals who, in the past, had been found to have a functional disorder, such as irritable bowel.

Enemy proteins of the intestine

Gluten is a set of proteins found in wheat, barley, rye and many other grasses.

Sensitivity to this substance causes gastrointestinal symptoms that can totally regress and do not depend on damage to the part of the intestine.

In contrast, celiac disease is a permanent intolerance due to an abnormal immune reaction triggered in the small intestine. This causes chronic inflammation that severely damages the intestinal villi, structures responsible for absorbing nutrients.

In contrast to gluten sensitivity, celiac disease has a genetic basis involving the DQ2 and DQ8 genes of the HLA system. In addition, in gluten sensitivity the intestinal immune barrier is not involved in the genesis of the disease, while the innate immune system would be involved.

Despite these differences, the symptoms of gluten sensitivity are similar to those of celiac disease: abdominal pain and bloating, burning in the mouth of the stomach, nausea, vomiting, constipation and diarrhea.

Other frequent disorders are joint and bone fatigue, muscle cramps, headaches, mental fogs and fainting, anemia, eczema and reddish spots on the skin, inflamed and sore tongue.

From suspicion to diagnosis to choose therapy

Precisely because of the high similarity in symptoms between the three diseases, only by excluding celiac disease or wheat allergy it is possible to diagnose gluten sensitivity.

Appropriate tests allow to eliminate the hypothesis of both respiratory allergies to gluten, and food and contact allergies.

Celiac disease, on the other hand, can be ruled out through a blood test that evaluates the presence of anti-tissue transgllutaminase (tTG) and anti-endomysium (EMA) antibodies and immunoglobulin A (IgA) deficiency.

Finally, intestinal biopsy allows to evaluate the degeneration of villi and the increase of lymphocytes in the intestinal mucosa, typical of celiac disease, but not of gluten sensitivity. Finally, in case of gluten sensitivity, but not celiac disease, there is the presence of anti-gliadin IgA and IgG antibodies and the HLA DQ2 and DQ8 genes.

Confirmation of the diagnosis is by evaluating the response to therapy, which consists of a gluten-free diet.

In fact, if the disease has been diagnosed correctly, the symptoms disappear even with a temporary suspension of the consumption of foods containing gluten. Those suffering from celiac disease, on the other hand, must give up for life the foods that may contain this substance, under penalty of reappearance of symptoms and a new damage to the intestinal villi.

In case of wheat allergy, however, the simultaneous administration of cortisone is also necessary.

In search of safe food

The European community has strictly established the criteria according to which a food product can be certified gluten-free: the gluten content must be less than 20 ppm, ie 20 mg per kg of product.

If, on the other hand, gluten levels are between 21 and 100 mg per kg, the products will be defined as “very low gluten”. A further certification is given by the presence on the packaging of a mark representing a barred ear, which marks gluten-free foods.