What is the difference between celiac disease and wheat allergy?

Celiac disease and wheat allergy are two distinct conditions. Celiac disease, or "celiac sprue," is a
permanent adverse reaction to gluten. Those with celiac disease will not lose their sensitivity to this
substance. This disease requires a lifelong restriction of gluten.

The major grains that contain gluten are wheat, rye, oats, and barley. These grains and their by-products
must be strictly avoided by people with celiac disease.

Wheat-allergic people have an IgE-mediated response to wheat protein. These individuals must only avoid
wheat. Most wheat-allergic children outgrow the allergy.

While food labels don't include every possible allergen, they do list the top eight, which account for 90
percent of all documented food allergies:

* Milk
* Eggs
* Peanuts
* Tree nuts (such as almonds, cashews, walnuts)
* Fish (such as bass, cod, flounder)
* Shellfish (such as crab, lobster, shrimp)
* Soy
* Wheat

Gluten Intolerance: Against the Grain

Do wheat products cause intestinal trouble? Try these tips for a gluten-free diet.
By Elizabeth M. Ward, RD
WebMD Feature
Reviewed by Brunilda Nazario, MD

You suspect pasta, bread, and crackers are making you sick. You may not have a name for your condition,
but one thing's for sure: avoiding grains is challenging.

Many people blame wheat, found in most of the grain-based products, for causing their abdominal pain,
gas, bloating and diarrhea.

"But more likely, gluten is what's irritating your gut," says Leslie Bonci, MPH, RD, author of the American
Dietetic Association Guide to Better Digestion.

Gluten, the protein found in wheat, rye, and barley, is the common denominator in most of the grain-based
products we eat, such as cereals, breads, and pasta.

Simple gluten intolerance can be uncomfortable, but the symptoms are fleeting, Bonci says. The good news
is that gluten intolerance is not a food allergy, and eating gluten does not usually cause damage – unless
you have celiac disease.
Celiac Disease: When Symptoms Are More Serious

More serious gluten intolerance is called celiac disease. That's when gluten actually triggers the body's
immune system. When people with celiac disease eat foods or use products containing gluten, their
immune system responds by damaging the villi -- tiny, fingerlike projections in the small intestine that
absorb the nutrients from food. For this reason it's considered an autoimmune disease.
Celiac disease, which also goes by the names gluten-sensitive enteropathy, nontropical sprue, and celiac
sprue, is a genetic disease. This means it can run in families. And it has far-reaching effects.

"Celiac disease is not just a disease of the gut," says Shelley Case, R.D., nutrition consultant and author of
Gluten Free Diet: A Comprehensive Resource Guide. "It's a multi-system, multi-symptom disease with
serious implications."

Celiac disease is linked to malnutrition that can lead to anemia, osteoporosis, depression, behavioral
problems, and stunted growth in children, among other problems. People who have celiac disease may also
have other autoimmune conditions, such as type 1 diabetes and rheumatoid arthritis.
Celiac Disease: An Unrecognized Problem

Until fairly recently, celiac disease was considered rare among Americans. In 2003, the results of a large,
multi-center study published in the Archives of Internal Medicine found celiac disease in one in 133
Americans. Among those with parents, siblings, or children with celiac disease, up to one in 22 people in
the study had it.

As many as three million Americans have celiac disease. Most of them don't know it, largely because celiac
disease can be difficult to nail down.

"It takes most adults about 12 years to get a definitive diagnosis of celiac disease," says Michelle Pietzak,
MD, a pediatric gastroenterologist, professor of pediatrics at the Keck School of Medicine of the University
of Southern California, and one of the authors of the landmark study.
Gluten Intolerance: Searching For Answers

If you think you suffer from celiac disease, resist putting yourself on a gluten-free diet. At least not yet.
"When you go off gluten, your gut starts to heal, and you won't have the markers in your blood or your gut
tissue that indicate celiac disease," Case says.

Instead, see a doctor for testing and a firm diagnosis. Your doctor usually orders blood tests to help
diagnose celiac disease. The two most frequently ordered tests are the endomysial antibody and tissue
transglutaminase antibody tests.

If antibody tests suggest celiac disease, you'll need to confirm the diagnosis with a biopsy of your small
intestine. The appearance of Dermatitis Herpetiformis (DH), an itchy, blistering skin rash is also a strong
indicator of celiac disease.
Adapting to a Gluten-Free Diet

You absolutely must avoid gluten if you have celiac disease. That's the only way to halt the disease's
symptoms, heal existing villi damage, and prevent destruction of the small intestine. Even if you have only
a mild reaction to gluten, you may decide to keep this protein out of your diet.

But gluten-free living is no mean feat. That's why it's important not to go it alone. You may think you're
doing a good job of getting rid of gluten, but you may not be aware that gluten lurks in a number of
processed foods, including:

* Salad dressings
* Yogurt drinks
* Frozen yogurt
* Cold cuts
* Egg substitutes
* Beer
Designing a Gluten-Free Diet

Pietzak says it's important to seek help from a registered dietitian when you decide on a gluten-free diet.
Registered dietitians are trained to design personalized gluten-free diets that work with your nutrient needs
and lifestyle. For the best results, choose a dietitian expert in gastrointestinal disorders.

Dietary counseling is even more important for children with celiac disease and their parents because
growing bodies have special nutrient needs. "If you have a child with celiac disease, you may want to
consider a gluten-free household to make life easier," Pietzak says.

A gluten-free eating plan seems restrictive because it eliminates many types of grain products such as
breakfast cereals, breads, and pasta. But it's not as harsh as it sounds.

"I tell people that the foods you should be eating a lot of anyway, such as fresh meats, fruits, vegetables,
milk, and legumes are naturally gluten-free," Case says. The key is knowing which grains to eat and which
to avoid.

Don't eat:

* Wheat and all its forms, including semolina, spelt, kamut, einkorn, and farro
* Rye
* Barley
* Triticale
* Oat bran
* Wheat germ
* Bran
* Graham, gluten, or durum flour
* Farina

Do eat:

* Amaranth
* Quinoa
* Buckwheat
* Popcorn
* Cornmeal (polenta and tortillas)
* Millet
* Breads, cereals, crackers, and pasta made of corn, rice, potato, soy, arrowroot, tapioca, sago, flax, and
hominy.

What about oats? Oats for celiac disease has been controversial, but recent research has spurred many
organizations to give oats the thumbs up. The problem is possible contamination of oats with other gluten-
containing grains. Case says pure oats – those not contaminated by other grains – are recommended by a
majority of celiac organizations in Canada and the U.S.

View Article Sources Sources

SOURCES: Leslie Bonci, MPH, RD, Director of Sports Medicine Nutrition at the University of Pittsburgh.
Shelley Case, B.Sc., RD, Case Nutrition Consulting. Michelle Pietzak, MD, Director of the Center for
Celiac Research-West, Childrens Hospital Los Angeles. Archives of Internal Medicine, 2003;163:286-292.
NIH Consensus Development Conference on Celiac Disease, June 28–30, 2004.
© 2006 WebMD, Inc. All rights reserved.
What Is Gluten Allergy?
The digestive disorder coeliac disease (gluten allergy) scars the lining of the small intestine preventing the
absorption of nutrients. Gluten allergy symptoms manifest as gastrointestinal distress of all forms.
Coeliac disease effects genetically predisposed individuals and can cause severe, lifelong disruption of their
dietary intake since gluten is found in wheat, rye, malt, barley and oats. In Western countries the condition
is extremely common. In the United States 1 in 133 people have gluten allergies.
Does Gluten Allergy Cause Serious Complications?
If left untreated, the damage caused by gluten allergies can cause anemia, bone diseases, and in some
instances even cancer. However, the good news is that when gluten has been removed from the diet the
damage caused to the bowel will improve and in many cases disappear completely.
What Are The Symptoms And Do They Differ In Children?
Symptoms of gluten allergy include a range of digestive issues such as indigestion, heartburn, and irritable
bowel syndrome. There may be unexplained weight loss, constipation, diarrhea, flatulence, minor rectal
bleeding, and acid reflux. Itchy dermatitis is also a symptom of this disorder as is excessive fatigue. Coeliac
disease is also associated with anemia, cardiomyopathy, depression, miscarriage, and peripheral
neuropathy.

Gluten food allergy in young children will cause weight loss and an extended abdomen. The effected
children will fail to thrive and will grow very slowly. This can continue into adolescence with puberty
being delayed. Children will also be irritable and will vomit easily. Some evidence suggests a link between
gluten intolerance and autism.
How Is a Diagnosis Made?
A major problem with diagnosing gluten allergy is the condition's tendency to be misdiagnosed especially
in the presence of diarrhea, frequent indigestion and irritable bowel syndrome. The best method to achieve
a conclusive diagnosis is upper endoscopy.

This minimally invasive procedure visualizes the upper part of the gastrointestinal tract through a plastic
tube that houses fiber-optic cable and the necessary circuits to transmit images back to the operator. It is
possible, via this method, to biopsy the duodenum, the first and shortest part of the small intestine, and the
area in which damage from gluten is visible. The test may be done twice, once with the patient on their
normal diet and once after they have followed a gluten-free regimen.

Unfortunately endoscopy is expensive and still too invasive for some people's tastes. There are gluten
allergy tests that can be run on blood samples but they do not tend to be reliable and also must be
performed twice, once on the individual's normal diet and once on a gluten-free diet. Given this
conundrum, many people who suspect they are gluten intolerant choose to simply remove the substance
from their dietary intake. If their gluten allergy symptoms subside, they opt to live with the complications
and challenges of being gluten free rather than seeing a return of their uncomfortable and disturbing
symptoms.