Gluten is a protein found in grains such as wheat, rye and barley (bread, pasta and cereal for example). For some people it’s a protein that needs to be avoided, as gluten can cause varying levels of reactions in those with a gluten allergy, an intolerance and coeliac disease.

Avoiding gluten can be a personal choice for those with an intolerance, as eating foods containing it can cause minor symptoms that can occasionally be tolerated. However, for those with an allergy and coeliac disease, it causes a more severe reaction, so avoidance is a necessity. We take a look at the differences between gluten intolerance, an allergy and coeliac disease, and explore the symptoms for each.

Which foods contain gluten?

Gluten is found in any food that contain the three cereals: wheat, barley and rye. For example:

  • pasta
  • cakes 
  • breakfast cereals
  • most types of bread
  • certain types of sauces 
  • some ready meals
  • beers that are made with barley.1

Gluten-free alternatives to the above can include oats (although some people with coeliac disease might be sensitive to them), buckwheat, rice, quinoa, polenta which is made from corn, and potatoes… fruit and vegetables are naturally gluten-free.

A general rule when looking to buy gluten-free products, is to check the labels. Although some products may be labelled as gluten-free, they may have been made or processed in a factory that handles gluten-based foods (particularly important for those with a severe gluten allergy).

How do I know if I have a gluten allergy?

Also known as a wheat allergy, it is characterised as your body’s reaction to certain proteins present in wheat. When consuming wheat (therefore gluten) an immune response is triggered, usually immediately, and your body starts attacking the proteins.

It’s worth noting that while gluten is one of the many proteins found in wheat, you might also be reacting to the other proteins, or a combination.2

The body’s immune system wrongly identifies one or more of the proteins in wheat as a threat, this results in chemicals, such as histamine, being released. It is these chemicals that result in allergic symptoms.2

Common reactions include:

  • a rash,
  • wheezing,
  • swelling of the lips, face or eyes,
  • and itching.

Symptoms can be mild to severe. The more serious reaction is anaphylaxis, which causes breathing difficulties, swelling in the throat and circulation problems, which can result in fainting or loss of consciousness. Severe allergic reactions require immediate medical treatment, as they can be life-threatening.

How is a gluten allergy treated?

Mild symptoms can be treated with antihistamine medicine for example, but avoidance is the best defence against allergies. Medication will relieve symptoms but will not change the allergic response.3

Adrenaline Auto-Injector devices (AAIs), also known as adrenaline pens or EpiPens, will be prescribed to those who are at risk of having a severe allergic reaction known as anaphylaxis.4

What is a gluten intolerance?

Also known as non-coeliac gluten sensitivity, this is different to an allergy because there is no immune system response nor is it life-threatening. Whereas an allergy causes immediate immune reactions, an intolerance typically involves reactions in the digestive system that may take longer to appear.

Difference between non coeliac gluten sensitivity/gluten intolerance and coeliac disease

Symptoms between the two may be similar but gluten sensitivity/intolerance does not appear to damage the lining of the gut, like coeliac disease does.5

Symptoms of gluten intolerance

If you have a gluten intolerance then your digestive system will have difficulty processing and absorbing gluten, resulting in discomfort and pain.6 Symptoms are usually temporary, but can include gastrointestinal symptoms such as:

  • bloating,
  • wind,
  • nausea or vomiting, 
  • abdominal pain, diarrhoea,
  • or constipation.6

Non-gastrointestinal symptoms can include:

  • fatigue, 
  • headaches,
  • joint pain,
  • skin rashes,
  • or brain fog.6

Symptoms are different for everyone and typically appear a few hours after consuming gluten. One person might only get a few of these symptoms whereas someone else may present nearly all of them.

If you believe you do have gluten intolerance, it’s best to visit your GP to have tests done to rule out other conditions such as coeliac disease, as they present similar symptoms.

Coeliac disease

Coeliac disease is a serious autoimmune condition that affects 1 in 100 people in the UK. Only 36% are medically diagnosed, meaning there are nearly half a million people living in the UK who are experiencing symptoms but don’t know they have it.7

Those with the condition would need to avoid gluten, as if consumed, it causes the immune system to attack the body’s tissues and damage the gut (small intestine), meaning the body cannot properly take in nutrients.8

Symptoms of coeliac disease

Eating gluten can result in a number of gut symptoms, including:

  • diarrhoea,
  • abdominal pain,
  • indigestion,
  • bloating,
  • and constipation.

Other non-gut related symptoms can include:

  • fatigue, due to not getting enough nutrients from food (malnutrition),
  • unexpected weight loss,
  • nerve damage,
  • an itchy rash.8

How to get tested

You should be tested for coeliac disease if you have any 1 of these symptoms:

  • persistent unexplained gastrointestinal symptoms, such as diarrhoea, stomach ache and bloating
  • faltering growth
  • prolonged tiredness all the time (fatigue)
  • unintentional weight loss
  • severe or persistent mouth ulcers
  • unexplained iron deficiency anaemia, or vitamin B12 or folate deficiency anaemia
  • type 1 diabetes
  • autoimmune thyroid disease, including an underactive thyroid (hypothyroidism) or overactive thyroid (hyperthyroidism)
  • irritable bowel syndrome (IBS) (in adults).

The NHS also recommends that if you have a parent, sibling or child with coeliac disease, then you should also get yourself tested.9

Testing involves a blood test to check for antibodies present in the blood. If antibodies are found then you’d be referred to a specialist in stomach and bowel conditions, who may carry out more blood tests or a biopsy of the intestine.

In some instances, there may be no traces of antibodies in the blood, yet symptoms persist. In this case, you may still be referred to a specialist.

Those with coeliac disease will need to follow a gluten-free diet for life as this is the only treatment for the condition. Following a gluten-free diet can be overwhelming at first but Coeliac UK has lots of support on their website to help you navigate what to eat.

>Check out our own gluten-free hot cross bun recipe

A gluten allergy, an intolerance and coeliac disease are all different and each carry their own symptoms and implications. But if you’re concerned about any of the symptoms mentioned or how your body reacts after eating foods that contain gluten, then see you GP. They can help determine whether it’s coeliac disease or not and help give answers on whether you need to follow a gluten-free diet.

References 

  1. Coeliac disease – NHS
  2. What is immediate wheat allergy? – Anaphylaxis UK
  3. How do I manage my allergy? – Allergy UK
  4. Adrenaline Auto-Injectors – Allergy UK
  5. Gluten sensitivity – Coeliac UK
  6. What is a gluten intolerance? – Digestive Health UK
  7. About coeliac disease – Coeliac UK
  8. Overview of coeliac disease – NHS
  9. Diagnosis of coeliac disease – NHS