You might think the answer is obvious, but you would be surprised.
⁉️I still receive referrals to my allergy clinic asking patients to be tested as they might have a coeliac allergy!
🔷️𝐂𝐨𝐞𝐥𝐢𝐚𝐜 𝐝𝐢𝐬𝐞𝐚𝐬𝐞 is a serious pathology where the body's immune system attacks itself.
🔷️𝗪𝐡𝐞𝐚𝐭 𝐚𝐥𝐥𝐞𝐫𝐠𝐲 is a reaction to proteins found in wheat. It can be either IgE (immediate) or non-IgE (delayed).
🔷️𝐍𝐂𝐆𝐈/𝐍𝐂𝐆𝐒 has symptoms similar to coeliac disease. Still not well known if or how the immune system is involved. There doesn't seem to have damage to the lining of the gut.
🔶️Gluten is a protein found in cereals.
🔶️When it is ingested, it leads to damage of the internal wall of the bowel with malabsorption associated problems:
➡️Less absorption of nutrients, minerals, and the fat-soluble vitamins A, D, E, and K (this one potentially leading to bleeding problems).
➡️Anaemia due to iron deficiency, low Vit B12 and Folic Acid.
➡️Osteopenia and osteoporosis due to lack of Calcium and Vit D.
➡️Weight loss, growth failure and/or delay in puberty and lethargy as side effects of a lack of carbohydrates and fats.
➡️Potential copper, selenium and zinc deficiencies.
▶️It can develop at any age.
▶️Diagnosis sometimes is not easy as symptoms can be vague. You need to be eating gluten for a diagnosis to be done.
▶️Even a breadcrumb can be damaging. It is a lifelong exclusion of gluten.
▶️It can be inherited, though there are new mutations. The chance to get it if a close relative has it is 1:10.
▶️It is neither an allergy nor an intolerance.
▶️It was thought to be rare, but it is believed to be underdiagnosed.
▶️People can have normal weight or overweight at diagnosis.
▶️You cannot grow out of it!
How to investigate and diagnose:
✅𝐂𝐨𝐞𝐥𝐢𝐚𝐜 𝐝𝐢𝐬𝐞𝐚𝐬𝐞 - Blood tests (TTg IgA and Endomysial Antibodies. Sometimes HLA DQ2 and HLA DQ8).
✅𝗪𝐡𝐞𝐚𝐭 𝐚𝐥𝐥𝐞𝐫𝐠𝐲 - Skin prick tests. Eventually, specific IgE and/or component diagnostics. Sometimes there is also the need for a food challenge. 🔜I will address this issue in another post.
✅𝐍𝐂𝐆𝐈/𝐍𝐂𝐆𝐒 - No validated test. Food exclusion, followed by food inclusion with symptoms coming back again, is the diagnostic took. Before this, Coeliac disease must be excluded.
Dr Costa is a Consultant Paediatrician and fellow of the Royal College of Paediatrics and Child Health.