Gluten is a hot topic these days, and is hitting the headlines again. Why? At the American College of Allergy, Asthma, and Immunology annual meeting, Dr. David Stukus (a pediatric allergist) set out to clarify frequent myths that he encounters in his practice. So, why is he saying that gluten allergies do not exist?
Gluten is a protein found in foods processed from wheat and related grain products. In celiac sprue (affecting up to 1% of adults), gluten intake leads to damage of the small intestine, impairing its ability to absorb nutrients. I like to imagine that a healthy small intestine is like a shag carpet and small intestine affected by active celiac sprue is more like a tile floor. Celiac sprue is not a gluten allergy, but rather an autoimmune condition where the gluten is triggering an inflammatory response in the body.
Studies find that far more people are adherent to a gluten free diet (a $1.31 billion industry in 2011) than have celiac sprue (also called celiac disease). This has led to the discovery of a separate condition, gluten intolerance (non-celiac gluten sensitivity). People with non-celiac gluten sensitivity have symptoms that are relieved with a gluten free diet but have no biopsy or blood test abnormalities. This is not clearly an autoimmune or allergic condition, though the exact cause of gluten intolerance is not yet understood.
Finally, there are patients with wheat allergies. However, gluten is only one component of wheat (and is in other grains). So a wheat allergy is not necessarily equivalent to a gluten allergy.
This isn’t to say that some people don’t suffer after eating gluten. There are several good reasons for gluten avoidance - whether an autoimmune disease (celiac), non-celiac gluten sensitivity or a wheat allergy - but most of them are not a true “gluten allergy.”
For a great summary of gluten from the perspective of a Registered Dietician, read this blog post.