It is difficult to prepare food for a group of children today without recognizing that the prevalence of food allergies has increased dramatically. Schools in which children routinely traded lunchtime peanut butter-and-jelly sandwiches in the 1980s now have peanut-free tables and peanut-free cafeterias. These precautions are necessary to protect the health of children afflicted with food allergies, and indeed, many parents may feel that not enough is being done. Just over the past two decades, there has been a change in the percentage of children with food allergies: from 3.4% in 1997-1999 to 5.1% in 2009-2011, according to a recent article in JAMA.
Today we look at one food item that provokes many different adverse health events: gluten. Gluten is the main group of proteins in wheat; it is also present in other grains, such as rye and barley. The parts of gluten that cause trouble for some individuals are gliadins and glutenins.
Many individuals choose a gluten-free diet -- or have it forced upon them by medical necessity -- but what are the reasons for this decision? A team of scientists writing in BMC Medicine recently recommended a new nomenclature to encompass all gluten-related health disorders.
First, the scientists divide the ailments into three categories: auto-immune; allergic; and non-autoimmune, non-allergic. Simply put, in an auto-immune disorder, the body attacks itself. Auto-immune reactions to gluten are often diagnosed weeks to years after gluten exposure. Auto-immune disorders related to gluten are celiac disease, gluten ataxia, and dermatitis herpetiformis.
Celiac disease can present with intestinal symptoms, or with more broader symptoms such as anemia or osteoporosis (which are due to damage to the intestinal mucosa). Blood tests are used to determine whether the antibodies that are celiac disease markers are present in the blood. As much as 1% of Americans are thought to have celiac disease. Gluten ataxia is a lack of voluntary coordination of muscle movements due to damage to the cerebellum from auto-antibodies created by the body in the presence of gluten. Dermatitis herpetiformis is a form of celiac disease in which the individual develops a skin rash in addition to the classic celiac disease intestinal rash.
Allergic disorders related to gluten are known broadly as "wheat allergy." Wheat allergy reactions are noted minutes to hours after gluten exposure, and are separated into four groups: food allergies (presenting as disturbances to the skin, GI tract, or respiratory tract); wheat-dependent, exercise-induced anaphylaxis (WDEIA); "baker's asthma" and rhinitis; and contact urticaria (hives).
There are also individuals who have gluten-related problems that are neither auto-immune nor allergic. These ailments are known broadly as gluten sensitivity. Gluten sensitivity does not involve anti-tTG autoantibodies (and thus is not celiac disease). However, individuals with gluten sensitivity have similar symptoms to those experienced by celiac disease patients, and find that the symptoms go away if they exclude gluten from their diets. In addition to the GI symptoms of individuals with celiac disease, gluten-sensitive individuals can experience a range of symptoms including joint pain, muscle cramps, and chronic fatigue. It is possible that 30% of Americans suffer from gluten sensitivity.
With greater understanding of the different health problems that result from gluten exposure, it is possible that more people may enjoy greater health. Scientists continue to explore the possible reasons for gluten-related health problems, and to educate patients about pathways to better health.