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ALLERGIES
ciated findings of atrophic villous damage and lymphocytic infiltra- and polyols (FODMAPs), present in wheat. The relatively newly
tion, however, the patient is clinically asymptomatic. In all forms of described disease entity, commonly referred to as “non-coeliac wheat
CD, adverse outcomes from continued gluten consumption can re- sensitivity” (NCWS), can present with a spectrum of signs and
sult in unexplained iron-deficiency anemia, osteopenia, transamini- symptoms that mimics celiac disease including IBS problems as well
tis, B12 and folate deficiency, and dental enamel defects. as many other extra-intestinal manifestations (malaise, fatigue, skin
rash, headache, paresthesias, fibromyalgia, depression, asthma, rhini-
Most of the physicians who first encounter patients with CD lack tis and confusion/concentration problems “brain-fog”). In a recent
the training and expertise to perform intestinal biopsies (the “gold report, it was found that NCWS causes quantifiable evidence of
standard” for CD diagnosis) however, in persons who are not IgA “systemic immune activation” and can result in “compromised in-
deficient and who are on gluten-containing diets, the diagnosis of testinal epithelium” (Gut 2016; 65(12); 1930-37). The diagnosis of
this disease can also be made by serologic screening for IgA reactive NCWS can be made in patients who are unresponsive to
to tissue transglutaminase (tTG-IgA). This test has been reported FODMAP-restricted diets, are negative for celiac associated anti-
to have a sensitivity of 95-98 percent and specificity of 95 percent. bodies and anti-wheat IgE, and yet continue to report symptoms
Although less reliable, in persons with IgA deficiency, testing to de- that occur shortly after wheat ingestion and resolve within a few
tect IgG reactive to deaminated-gliadin peptide and tTG can be per- hours (or days) after withdrawal. *For more details see: De Giorgio,
formed. R “Sensitivity to Wheat, Gluten and FODMAPs in IBS” Gut.
2016:65(1) 169-178.
Besides IgE-mediated wheat allergy and CD, the differential di-
agnosis for wheat-exacerbated gastrointestinal symptoms includes: Dr. Michael Vaughn is a board-certified allergist practicing in North
immune activation from non-gluten wheat proteins and the non- Central San Antonio since 1999.
immune mechanism of bowel distention caused by gas producing
bacteria that feed on the fermentable “oligo-di-mono-saccharides
visit us at www.bcms.org 15
