Understanding When The Gluten-Free Lifestyle Is Not A Choice…


There are a number of different conditions that have no other cure than a totally gluten free diet and in some cases even skin contact has to be avoided, although they are similar in certain ways, they are also very different in others and it’s quite easy to get confused.



Coeliac Disease (also spelled Celiac) is an autoimmune disease. The immune system attacks the gluten when it’s digested in the small intestine. This means that villi are slowly destroyed. Villi are small fingerlike projections into the lumen of the small intestine and they have an important role in the absorption of nutrients.

There is no cure for Coeliac Disease and the only way to avoid the damage gluten is doing to the body is a 100% gluten free diet. People who have Coeliac Disease don’t have to avoid getting in contact with gluten in any other way other then ingesting and digesting it. Diagnosing this disease can be difficult in some cases as there are a number of symptoms and not everyone has the most obvious ones.

The symptoms range from severe abdominal pain and diarrhoea to fatigue and ADHD like symptoms. Some people never manifest other symptoms than a few vitamin deficiencies. Diagnosis is a two step process. A blood test can confirm the presence of antibodies in the blood which can indicate Coeliac Disease.

To confirm the diagnosis a biopsy is needed where damage to the villi in the small intestine is investigated. In order to get an accurate and correct diagnosis gluten can not be cut out of one’s diet before the biopsy even if the blood test is positive. Blood tests can be inaccurate at times, this makes diagnosing Coeliac Disease even more difficult in some cases.



Coeliac Disease is often linked to Dermatitis Herpetiformis, also called Coeliac’s little sister. The most typical symptom is having groups of small, itchy blisters, these can appear anywhere on the body but the most common places include the back of the elbows, forearms and knees.

All patients with Dermatitis Herpetiformis have associated Coeliac Disease that could be described as latent Coeliac Disease due to the typical symptoms of the disease. Dermatitis Herpetiformis can be diagnosed with a simple skin test, where a small piece of healthy skin is examined, the presence of immunoglobulin A (igA) confirms the diagnosis. The diagnosis can also be confirmed with the same tests used for diagnosing Coeliac Disease.

The treatment is a life long gluten free diet, although medication might be needed at the very beginning in order to speed up the skin’s healing. Although DH involved the skin, just like in the case of CD, gluten has to be ingested and digested to cause a reaction. Therefore in both cases skin care products than contain wheat and/or gluten are safe.

There are a number of different allergies that are related to wheat and gluten.

  • Immediate IgE mediated allergy: this is caused by the immune system reacting to certain proteins in the wheat grain. Symptoms occur within two hours and include: asthma, hives, swelling or anaphylaxis. There may also be vomiting, diarrhoea, abdominal pain and a flare up of eczema.
  • Wheat dependant exercised induced Anaphylaxis: reactions only appear if exercising after eating wheat. Inhaling wheat can also cause asthma like symptoms. This is diagnosed by a combination of case history and skin prick tests or specific IgE blood tests.
  • Delayed allergy to wheat: does not involve IgE antibodies and symptoms can occur up to a few days after eating wheat. Symptoms include: diarrhoea, vomiting, abdominal pain and the flare up of eczema.
  • Intolerance due to gut fermentation: the symptoms (bloating, wind, abdominal pain)are caused by bacteria fermenting the poorly absorbed fructan. This is treated with excluding all fermentable foods from the diet.
  • Gluten sensitivity: it is unclear wether it’s cause by gluten alone or other proteins are involved. The most common symptoms are: abdominal pain, bloating, diarrhoea, nausea. This condition is also associated with non gut related symptoms such as foggy mind, joint pain, headaches and anxiety. This condition is diagnosed by excluding and a gluten exclusion diet.

It’s possible to develop an allergic reaction if contacting gluten/wheat through the skin but this is not Coeliac or DH related. This is an allergic reaction and it should be further investigated as it could be more complicated than just a gluten/wheat allergy.

Article Author: Emese Fayk


Now Read This: What Is The Difference Between Gluten-Free And Wheat-Free?

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