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What’s the Difference Between Celiac Disease, Non-Celiac Gluten Sensitivity, and a Wheat Allergy?

Laura Kunces, PhD, RD

What’s the Difference Between Celiac Disease, Non-Celiac Gluten Sensitivity, and a Wheat Allergy?

These three conditions have some overlapping symptoms and require avoidance of some of the same foods but are actually quite different in their etiology. Learn what differentiates these three health concerns. 

Celiac 101

Celiac disease is commonly referred to as a gluten-intolerance. Medically, celiac is an autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten causes one’s immune system to react in such a way that damages the lining of the small intestine. Believe it or not, about one percent of the population has celiac disease, which is considered relatively prevalent among conditions. It’s most common in people of northern European descent and can occur not only in infants but also in children, teens, and at any age through adulthood. So, if you are experiencing gut issues, you may have celiac, or it may be a non-celiac gluten sensitivity. 

What we know about celiac disease

Also called “non-tropical sprue,” “celiac sprue,” or “gluten-induced enteropathy,” celiac disease is a permanent but manageable inflammatory condition affecting the villi on the surface of the small intestine. Villi and microvilli are essential for normal digestion. When damaged, the intestine is unable to absorb the nutrients that are being consumed, which can result in malnourishment. Symptoms most commonly include upset stomach, diarrhea, pain, weight loss, and abnormal stools, and since the gut is related to every system in the body, one may also experience skin, mood, and immune function changes too. 

The intestinal damage associated with celiac disease can be serious. Intestinal permeability can permit toxins, bacteria, and undigested foods to seep through the intestinal barrier and end up in your bloodstream.

The genetic link to celiac disease

As we’re learning more about it, we can confidentially discuss the genetic predisposition in markers HLA-DQ2 and HLA-DQ8 as one variable relating to those with the disease. One retrospective study found 98.4 percent of the 74 people with celiac had the HLA-DQ2 or -DQ8 antigen present; about 11 percent had both. Within that group of adults, the HLA-DQ2 antigen is more common – found in about 80 percent of adults with celiac. About eight percent of this group had HLA-DQ8. 

And because this disease is commonly inherited, the study also looked at the relatives of celiac patients, of which 90 percent had one or the other antigen, presenting in a similar 8:1 ratio of HLA-DQ2 to HLA-DQ8.1 

Something to consider is the relatively high number of people who have the same antigens but are not affected by gluten consumption. In a group of 109 non-celiac adults who were also without a family history of celiac, almost 56 percent had HLA-DQ2 or -DQ8 when tested. 

What does that mean for you? It is possible to have the HLA antigens present and not have a gluten-intolerance as it seems to be a common antigen – and that the HLA antigens should not be used as the sole diagnostic criterion for celiac.1

If you have celiac, you should avoid gluten at all costs. Gluten is a protein found in grains – not just in wheat. Read labels, educate yourself what foods have gluten in them, and find recipes that work for you and your gut. But diagnosed with celiac disease or not, are you still experiencing gluten-related issues? Depending on your reaction, you may have a non-celiac gluten sensitivity or a wheat allergy.

Non-celiac gluten sensitivity

While you may not have a true celiac diagnosis, your gut may still be bothered. You may experience headaches, brain fog, joint pain, and GI issues within hours or sometimes days after eating foods containing gluten. The main differences between celiac and non-celiac gluten sensitivity are the missing antibodies and lack of major intestinal damage. But just because you may not have physical intestinal damage doesn’t mean your gut isn’t suffering from other harmful and annoying symptoms!

Some individuals with non-celiac gluten sensitivity may experience minimal intestinal physical damage, which is usually resolved after following a gluten-free diet. Like those with celiac disease, following a gluten-free diet is your best bet.

Wheat Allergy 101 

A wheat allergy is different than both celiac and non-celiac gluten sensitivity. It is most common in children, who tend to outgrow it by adulthood. Interestingly, about 1 in 5 individuals with a wheat allergy are allergic to other grains as well. A wheat allergy is a food allergy that triggers the immune system to fight back when ingested, but the response is more like other “allergies.” With a wheat allergy, there are fewer GI issues and more symptoms related to the skin and respiratory system. 

The most common milder symptoms include hives, skin redness, itching, and sneezing, while more serve symptoms like swelling in the tongue and throat, difficulty breathing, wheezing, a loss of consciousness or even a coma or death can occur. As with any allergy, symptoms can escalate quickly, depending on the exposure and response. Therefore, no symptom should be ignored. 

Being allergic to wheat means you don’t have to avoid all of the foods that those with celiac or non-celiac gluten sensitivity have to avoid. Luckily, packaged foods are required to note on the label if it contains wheat, but you will still want to learn what other recipes are likely to include it too. And it is also essential to take note of any self-care products (lip balms or lotions) that might contain wheat because even topical exposure may be harmful. 

Although Onegevity’s Gutbio test does not provide a diagnosis of these or any conditions, individuals may seek microbiome testing to understand what is going on in their gut microbially. Consider a Gutbio test to see what dietary recommendations can help support your gut diversity or if any pathogens are present that may be another reason for gut issues. 

1.     Cecilio LA, Bonatto MW. The prevalence of HLA DQ2 and DQ8 in patients with celiac disease, in family and in general population. Arq Bras Cir Dig. 2015;28(3):183-185.