Ask Shelley Case: The Difference Between Celiac Disease, Gluten Sensitivity and a Wheat Allergy

I am confused about these 3 conditions. Can you tell me more?

What a great question and one that is confusing to many people! The following are some facts and pointers regarding each of these conditions to  help you understand the differences in these somewhat similar, yet very unique medical conditions:

Celiac Disease (CD)
This is one of the most common inherited disorders with an estimated prevalence rate of  1:100. Celiac disease is an autoimmune disorder in which the villi of the small intestine are damaged by specific proteins in the grains wheat, rye and barley (collectively called gluten). Symptoms of CD are highly variable, may occur at any age, including the elderly, and involve not only the gastrointestinal system but many other organ systems.  Gastrointestinal symptoms range from nausea, reflux, bloating, gas, diarrhea and/or constipation.  Other symptoms can include fatigue, weight loss (note CD can also occur in obese individuals), mouth ulcers, dental enamel defects, bone and joint pain, easy bruising of the skin, menstrual irregularities, miscarriage, infertility in both women and men, migraines, depression, ataxia, seizures, neuropathy, lactose intolerance and elevated liver enzymes.

Another presentation of CD is the skin condition dermatitis herpetiformis (DH) that is characterized by an intense burning, itchy rash that is symmetrically distributed.

Untreated celiac disease can result in nutritional deficiencies such as anemia and osteoporosis, as well as development of other autoimmune disorders (e.g., thyroid disease, arthritis, liver disease) and intestinal cancers.

There are specific blood tests (TTG and EMA) that can be used to screen for CD, however the only definitive test for diagnosis is the small intestinal biopsy. Diagnosis of DH is a skin biopsy from unaffected skin adjacent to the blisters or erosions. A gluten-free diet should never be started before the blood tests and biopsy are done as this can interfere with making an accurate diagnosis.

Once a diagnosis of CD is confirmed, the treatment is a strict gluten-free diet for life. For more information on the gluten-free diet see

Gluten Sensitivity (GS)
Recent research has revealed that it is possible to be sensitive to gluten and not have celiac disease or wheat allergy.  Although the exact mechanisms and prevalence of GS is not known at this time, Dr. Fasano from the Center for Celiac Research in Baltimore has recently published several papers on this topic. There appears to be differences in gut permeability and the immune system of those with CD compared to individuals with GS.  GS is not an autoimmune disease, is not accompanied by elevated tissue transglutaminase antibodies (TTG) and does not result in increased intestinal permeability or severe intestinal damage. However, it is interesting to note that IgA and IgG antigliadin antibodies (AGA) were elevated in almost 50% of the cases in the Fasano study.  Elevated AGA levels have also been seen in schizophrenia, ataxia (loss of muscle coordination) and other conditions.

Symptoms of GS can be similar to CD such as abdominal pain, bloating, gas, diarrhea, unexplained anemia, muscle cramps, leg numbness, and bone or joint pain.

Currently there are no specific tests for diagnosing GS. The only way to determine if someone has GS is by ruling out CD and wheat allergy, then seeing the response to a gluten-free diet and a gluten challenge. It is not known whether someone with GS must strictly avoid gluten for life like those with CD.

The Center for Celiac Research estimates that GS may affect 6-7% of the population compared to 1% for those with CD. Dr. Fasano will be speaking at the International celiac disease conference in Oslo, Norway June 19 at a session called Gluten Sensitivity: More Than Celiac Disease. So stay tuned for more information in my upcoming columns.

Wheat Allergy
A food allergy is an abnormal immune reaction to naturally occurring proteins. The most common food allergens are wheat, egg, peanut, tree nuts, fish, shellfish, soy and milk. Food allergies are estimated to affect approximately 5 to 6% of young children and 3 to 4 % of adults in westernized countries.

When someone with wheat allergy consumes foods made with wheat, it triggers the release of a specific antibody called Immunoglobulin E (IgE) from various cells in the body. This IgE circulates throughout the bloodstream and causes other cells to release inflammatory chemicals such as histamine. This immune response or allergic reaction may result in a variety of symptoms that can be mild to life threatening anaphylaxis that can occur within minutes to a few hours. It can affect the skin, gastrointestinal tract, respiratory system and/or cardiovascular system. Symptoms of wheat allergy can include swelling and itching in the mouth, hives, itchy rash, eczema, itchy and watery eyes, nasal congestion, abdominal cramps and pain, diarrhea, tightening of the throat and trouble breathing and swallowing, dizziness and a drop in blood pressure. Unlike CD, wheat allergy does not result in severe intestinal damage.

Wheat allergy is more common in infants and young children, and is frequently accompanied by other food allergies. Adolescents and adults can be allergic to wheat although it is not as common as in children. It is estimated that approximately 0.1% of the population has wheat allergies.

The only treatment for wheat allergy is to follow a strict wheat-free diet. But the good news is that the majority of children will outgrow their wheat allergy over time. Check out this link for more information about food allergies and food intolerances.

Ask Shelley Case is a feature of It is published the second Tuesday of each month. Shelley Case, RD is a Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at:

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12 Responses to “Ask Shelley Case: The Difference Between Celiac Disease, Gluten Sensitivity and a Wheat Allergy”

  1. Sue Edwards Says:

    This was very informative. I have a kiddo who is allergic to all of the common allergies. I am gluten sensitive. I have yet to be tested as my doctor does not believe I can have issues with wheat and gluten. I diagnosed myself years ago, have been eating gluten free for about 3 years and I feel so much better. Now I have to get my kiddo to buy into this.

  2. Traci Says:

    Shelley – Thanks for this detailed explanation of the differences! I’m curious, where does Gluten Ataxia fall on this list?

  3. Debbie Says:

    Thank you so much for the defining the difference. I was tested for celiac about 5 years ago, but because I had not eaten gluten my blood test was negative. I believe I have a gluten sensitivity but it has not been confirmed by a medical doctor.

  4. Crystal Says:

    I am sooo confused about this. I have done other research on the subject of the differences and this is the first time I have come across this defining difference. Other sources say that the skin rash is from the allergy not from Celiac Disease. My doctor said that there are two different allergies that get tested in your blood. I believe they are the ones in this article. ( IgA and IgG antigliadin antibodies ) And that one is for testing for Celiac and the other is the allergy. My blood work came back saying I had the one for Celiac present. I did not have the biopsy because I didn’t have insurance at the time. According to this article I could have the sensitivity. I would also be interested in knowing what causes the symptoms for those with the sensitivity. For those with Celiac it isn’t just that the grains cause the damage in the intestine. It is because your body reacts to it like it is an allergen. The antibodies are then released and attack the gluten and the villa in your intestine. That is how the damage results. That is how the scarring takes place and thus you have constipation, diarrhea, and other symptoms. At least this is what I have found in my research. So if what I have found is true then how does the symptoms occur from the sensitivity?

  5. Shelley Case, RD Says:


    You’ve asked many good questions, and I hope that the following facts and information help to clarify some of them:

    1. There are many causes for skin rashes such as allergies (e.g., hives and eczema), psoriasis and dermatitis herpetiformis (DH). Dermatitis Herpetiformis is the skin presentation of celiac disease and is characterized by an intensly itchy rash that is symmetrically distributed. Diagnosis of DH is made from a biopsy of uninvolved skin adjacent to an eruption. The biopsy is tested for granular IgA deposits under the top layer of skin. For more information see

    2. There are several celiac screening tests available that are very specific and sensitive including IgA and IgG tissue transglutaminase and IgA endomysial antibodies. The IgA and IgG antigliadin antibody tests are not as sensitive and specific for celiac disease and can be elevated in cows milk enteropathy, giardia and other conditions which is why they use TTG and/or EMA in the screening for celiac disease.

    3. Allergy testing involves skin tests (a small amount of the suspected allergen is place on or below the skin) and/or blood tests (looking for IgE antibodies that are made in response to certain allergens).

    4. Scientists do not know the exact mechanism that causes symptoms in those with non celiac gluten sensitivity. More research is definitely needed!

    5. Celiac disease is not an allergy. It is an autoimmune reaction where the body attacks its own healthy tissues when gluten is consumed. The immune system think gluten is a foreign body and causes inflammation in the small intestinal villi and other organ systems leading to a wide variety of symptoms. For more information about the mechanisms and the immune system I highly recommend “Celiac Disease for Dummies” page 23-44 that goes into great detail about the process of celiac disease and how it differs from allergies.

  6. kellie Says:

    To add to the questions, I was told that with the gluten problems usuallyit is more of the process of foods that people have a problem with. What’ your take on this idea?

  7. Cameo Says:

    Great post! I self-diagnosed and have avoided gluten and dairy since the beginning of 2011 and honestly have never felt better. My skin is brighter, my nails are long and strong and my GI stuff is not nearly as, um, inconvenient. However, I never went to an MD to get a blood test (have been meaning to…) after reading this, I wonder if I still ought to? Having been gluten free for 6mo now? What do you think?

  8. Shelley Case, RD Says:

    Cameoe’s comment about being on a gluten-free diet and wondering about getting tested for celiac disease is a common one.

    In order for the celiac blood tests and small intestinal biopsy to be accurate, you must be eating gluten. Unfortunately there are no clear cut guidelines for how much gluten to consume and for how long before getting tested. Some celiac experts recommend a minimum of 10 grams of gluten (about 4 slices of bread) for adults and 5 grams of gluten for children for at least 4-6 weeks. However it has been reported that it may take months of continued gluten consumption before the tests will be positive. Unfortunately, if you have undiagnosed celiac disease and then try a gluten challenge you may get very sick and not able to eat that much gluten for a significant period of time. So then you are left not knowing if you really have celiac disease or not.

    The only other option is to consider genetic testing for the HLA markers DQ2 and DQ8. If it is negative then it is very unlikely you have celiac disease because 98% of individuals with celiac disease have one or both of these genetic markers. But if you are positive for the genetic markers it does not mean you have celiac disease because 40% of the general population also are positive for one of these markers and do not have celiac disease.

    So if eliminating gluten makes you feel better and consuming gluten makes you sick, then you have to assume you may have celiac disease or non celiac gluten sensitivity. But with any medical issues, it is important to consult withyour physcian.

    For those people out there who think they may have celiac disease or non celiac gluten sensitivity, it is important to get tested BEFORE you start a gluten-free diet.

  9. Celiac Disease, Gluten Sensitivity, or Wheat Allergy? « Gluten Free in Binghamton Says:

    […] […]

  10. Faith Says:

    I have had issues with severe insomnia and gut problems for as long as I can remember. My family doctor just kept putting me on different anti-depressants and more Prevacid, which has done nothing to help. I ended up with gastroparesis, and was in extreme pain. The gastronentonologist said that they have no idea why my stomach shuts down and gave me no ideas on what kind of diet to go on. I’ve been on liquid diets for months at a time because of this issue and found out the reason I was stuck on antibiotics for weeks at a time was because of it’s side affects. It was supposed to give me diareah and make me sick to force my stomach to work. NICE!!! NOT!
    My sleep specialist mentioned going on a gluten free diet because he said that the same gamma waves in the brain that cause inability to sleep also cause stomach issues. Sadly, this brilliant man is no longer working there so I can not talk to him anymore. I hope that his God given knowledge will benefit others where he is at now. Willing to try anything, I researched this diet and went to a naturopath. She told me that my stystem was highly sensitive to wheat. Aha, so I caved and went on a gluten free diet. I am now off of Prevacid and no longer constantly nauseated and in pain. I also no longer take Reglan, which was used to force my stomach to work and caused horrible side affects. I’m also weaning off of my anti-depressant, which has not helped me in any way. I have lost a significant amount of weight in this past year and finally my doctor did some beyond basic testing on my thyroid. I get horrible migraines, diarreah, joint pain, fatigue, more frequent periods, heart beating so hard in my throat that it hurts, sugar issues- going to high and being thirsty and peeing all the time to sugar lows and getting migraines. I’ve never had migraines before the past year, now they are becoming more freqent. My TSH level is 0.073 when the normal range is 0.358-3.740. My alkaline phosphotase which is supposed to be between 50-136 is at 36 and AST(SGOT) supposed to be between 15-37 is at less that 3. My WBC is at 3.8 when is is supposed to be at 4.0-10.8. I also have a tumor on my thryroid. The endocrinologist treated me as I was a fly that needed to be stomped upon and completely dismissed me. I was hoping for some answers, but he said acted as if my problems were so insignificant that they did not require treatment. I went out of there just crying.
    My doctor does not believe I have celiac but since the test was done after being on a gluten free diet for two months it may be a false positive. I have tested it a few times accidentally, I might add. One time I took one small bite of what I thought to be a gluten free muffin and realized as soon as I had that I was wrong. my friends said, hey, maybe you can eat gluten after all,don’t worry about it. Well by that evening I had the worst reflux, nausea and diahreah I’ve had in a while. I don’t know what to think and why doctors are unwilling to treat the thyroid. Now I’m trying natural helps with loads of vitamins and sticking steadfastly to my gluten free diet. I may not be celiac, but I sure feel a LOT better without gluten. Don’t know what has to happen to get thryroid help though. I am beyond frustrated. Do I have to black out on the road like I did in church a few weeks ago and get killed or worse get my children killed to get attention!!!!???? If I was not a Christian and believed in suing, I would have already done after that rude uncaring endocrinologist. I miss out on so much of life because of these issues, but that doesn’t matter to him.
    I did go to the gluten free food fair this past year and it really opened my eyes. One of the lectures was like “explaining my life to a T!” Couldn’t believe it. Now why wont the doctors believe me????

  11. Kathleen Reale Says:

    Wow… you’ve been through a lot! I think that the best advice anyone can give you at this time is to find a good doctor that will do a biopsy to test you for celiac (and lead you in the right direction for your other medical issues). You mention you went to a GF Food Fair this past year? Was that affiliated with a local celiac support group? Maybe one of the members of that group can point you in the direction of a good doctor that can get you on the track to better health. It’s worth reaching out to them to get a good recommendation.
    Best of Luck and, as always…

    Be Free!

  12. Shelley Case, RD Says:

    Traci asked about ataxia.

    In celiac disease, gluten not only affects the gastrointestinal tract but other organ systems, resulting in a wide variety of symptoms. Some people develop neurological symptoms such as neuropathy, seizures, migraine headaches and ataxia (problems with balance and coordination).The only treatment for celiac disease is a strict gluten-free diet. Elimination of gluten will cause the small intestinal villi to heal over time and many symptoms of celiac disease will resolve. However for those with a delayed diagnosis of celiac disease and long standing neurological symptoms such as ataxia and neuropathy, symptoms may or may not improve.

    Dr. Hadjivassiliou, a British neurologist and researcher, has been studying ataxia for many years. He has found that some individuals with ataxia are gluten sensitive but do not have celiac disease. A high prevalence of these individuals has elevated antigliadin antibodies yet the other celiac antibody and biopsy tests are negative. If no other cause for the neurological dysfunction is found, he recommends a strict gluten-free diet with regular monitoring. He reports that neurological symptoms usually show improvement after one year on a strict GF diet and antigliadin antibodies normalize, especially if diagnosed and treated early. However, some researchers do not support the diagnosis of gluten ataxia and a small study of 32 patients with ataxia did not have elevated antigliadin antibodies. Clearly more research is needed in this area.

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