Today, March 20, World Flour Day is celebrated in order to recognize and value all the work that is done so that the grains of wheat travel the long way from the fields to your table in the form of a chocolate Neapolitan or spaghetti carbonara. However, not everyone can enjoy foods containing wheat, either due to allergy or intolerance. But are these diseases the same?
Similar diseases… but different
Before going into the mechanisms of these diseases and their characteristics, it is important to clarify that today the use of the expression “gluten intolerance” is not accepted. The correct thing is to talk about celiac disease and sensitivity (allergy) to wheat or any of its compounds.
Although the main recommendation is to avoid the consumption of wheat or derivatives if you suffer from any of them, these diseases are very different. Experts define a food allergy as a rapid adverse reaction caused by contact with a food during which there are demonstrable immunological mechanisms. One of the immunological participants are IgE antibodies, immune system agents that, upon detecting wheat allergens, activate a series of defense cells, thus causing the different symptoms. It could be said in a simple way that an allergy is an adverse reaction to something that is not harmful to our body but from which, however, we defend ourselves. As if there was a glitch in the system.
On the other hand, intolerances encompass different mechanisms and elements, but can be summed up in the inability to process certain compounds of a food, which brings about a series of physiological consequences and symptoms. In celiac disease, the disease appears due to the inability to process and assimilate gluten correctly. Although here we also have antibodies involved, they are of the IgA type, and are not capable of causing allergies.
What are your symptoms?
Both wheat allergy and celiac disease can present some common symptoms, but the pathology or mechanisms behind it are very different. As the diagnosis of allergies and intolerances has become very important in recent years, one of the great changes has been seen in gastronomy, since codes have been implemented in restaurants to know what compounds each dish contains. The code for wheat and its derivatives is the letter A, and it actually refers to any cereal that contains gluten, but this is also an essential code for those allergic to wheat or wheat flour.
Wheat allergy cause mild to moderate symptoms ranging from eczema, asthma, abdominal pain, to nausea and vomiting. If a person has a sensitivity to wheat, they could experience any of these symptoms if they mistakenly ate a food that contains it. On the other hand, we have wheat flour which has gone through several processes and as a consequence, some of the allergens have been lost, so allergy to wheat flour is even less common. However, this allergy can be much more dangerous due to what is known as exercise-induced anaphylaxis.
People who suffer from this rare type of anaphylaxis, when exposed to wheat flour, accumulate the allergen in their body without causing any symptoms. The problem arises if this person performs physical exercise, since the allergen enters the circulation and is quickly distributed throughout the body , activating different cells of the immune system through IgE antibodies. This causes a chain reaction within the body whose symptoms can be fatal: anaphylaxis. Although this type of anaphylaxis is very rare, a correct diagnosis is essential. So, once diagnosed with a wheat allergy, it’s enough to avoid all foods marked with code A, right? Well, I’m sorry to tell you that it’s not always that simple, because there are many other products (besides food) that can contain traces of wheat and cause allergic reactions. For example, a study in Japan found that a facial soap (Cha no Shizuku) contained hydrolyzed wheat protein and people sensitive to wheat had skin reactions when using it. Due to these reactions, there is more and more control in the manufacture of products that can be in contact with our skin to reduce contamination with allergens as much as possible.
As you can see, it can be of vital importance to have the proper diagnosis in the event of an adverse reaction to the intake of foods that contain wheat or its derivatives.
How do you know if you have an allergy or intolerance to wheat?
Celiac disease can be more complicated to diagnose, in addition to the large percentage of asymptomatic patients in this disease. On the other hand, the diagnosis of allergies can be easier since a simple blood test can tell you if there are antibodies (IgE) against the different proteins (allergens) in wheat. These antibodies are a good indicator, although not definitive, of allergic sensitivity and in combination with other tests they can confirm or rule out allergy.
However, the most important thing is to go to a specialist if you have symptoms or suspect you have some kind of reaction to eating any food and follow the international recommendations reviewed by experts on the subject.
References:
Muraro et al. 2014. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. allergies. doi: 10.1111/all.12429Al-Toma et al. 2019. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. doi: 10.1177/2050640619844125Christensen et al. 2019. Wheat-Dependent Cofactor-Augmented Anaphylaxis: A Prospective Study of Exercise, Aspirin, and Alcohol Efficacy as Cofactors. J Allergy Clin Immunol Pract. doi: 10.1016/j.jaip.2018.06.018Fukutomi et al. 2014. Epidemiological link between wheat allergy and exposure to hydrolyzed wheat protein in facial soap. allergies . doi: 10.1111/all.12481
