Non-Celiac Gluten Sensitivity (Gluten Intolerance)

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Some individuals have a reaction to gluten which is not an autoimmune or allergic response. These people experience distress when eating gluten containing foods and show improvement when following a gluten-free diet. This is generally defined as non-celiac gluten sensitivity or gluten intolerance.

Non-celiac gluten sensitivity is clinically less severe than celiac disease. Gluten ingestion will cause adverse gastrointestinal symptoms similar to celiac disease, but it does not cause an increase in antibodies or significant damage to the small intestine. Early studies have shown that those with non-celiac gluten sensitivity have extra-intestinal symptoms such as a rash, headache, “foggy mind”, fatigue, diarrhea, depression, anemia, numbness in extremities and joint pain. Symptoms typically appear hours or days after gluten has been ingested.

Non-celiac gluten sensitivity should be differentiated from a wheat allergy. Allergies, including those to wheat, are associated with high IgE levels in the blood. Diagnosis of a wheat allergy is made through skin prick tests, IgE serologic testing and a food challenge. Gluten sensitivity is a diagnosis of exclusion, meaning both celiac disease and a wheat allergy should be ruled out first. Currently there is no blood test for gluten sensitivity. If gluten sensitivity is suspected, it is recommended to first test for a wheat allergy and celiac disease with serologic testing and possible small intestinal biopsy. If tests for both celiac disease and a wheat allergy are negative, then a gluten-free diet should be recommended. If symptoms improve on a gluten-free diet, then the diagnosis is likely non-celiac gluten sensitivity.

Some individuals are already on a gluten-free diet and feel much better with gluten avoidance. It should not be assumed that these individuals have non-celiac gluten sensitivity. Because celiac disease is a lifelong condition with potential serious complications, it is important that an accurate diagnosis is made.

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