A recent addition to the spectrum of wheat sensitivity — beyond celiac disease, dermatitis herpetiformis, wheat allergy and non-celiac wheat sensitivity — is adverse reaction to wheat.
In industrialised nations such as the United States, the United Kingdom and Germany, about 20% of the population report adverse reactions to food (ARF), with wheat, nuts, fruit and milk among the most common triggers. Most ARF are not mediated by the immune system — lactose intolerance, for example, is the most common ARF worldwide. ARF can cause gastrointestinal and/or extra-intestinal symptoms.
Gastrointestinal food allergies (an IgE immune response) do exist in children and adults, but most ARF symptoms come from non-immunological reactions to food. Testing antibodies to food proteins (IgE, IgG, IgA, IgM) has clinical value, but relying on it alone can be limiting.
Beyond gluten
ARF highlights that wheat gluten may not be the only culprit. Research suggests that many components other than gluten could trigger the immune reaction. Gluten is clearly the culprit in celiac disease; other potential culprits include:
- Amylase-trypsin inhibitors (ATIs)
- Wheat germ agglutinin (WGA)
- Fructans (found in FODMAPs)
References
- Al-Toma A, Volta U, Auricchio R, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 2019. doi:10.1177/2050640619844125
- Uhde M, et al. Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease. Gut. 2016;65(12):1930–1937. doi:10.1136/gutjnl-2016-311964