Gluten allergy, otherwise known as gluten-sensitive enteropathy or coeliac disease, is an immune system disorder, affecting an estimated 1 in 300 Americans. People suffering from the disease react to gluten in food containing wheat, barley, and rye. More specifically, in individuals with gluten allergy, the gluten damages the lining of the small intestine, causing malabsorption and malnutrition.
The small intestine is normally lined by villi, which enhance the absorption of nutrients. In people with gluten allergy, the immune system attacks the villi, leading to a partial or complete loss of villi, and subsequent decline in nutrient and vitamin absorption, and enzymatic digestion. The biggest risk factor for gluten allergy is a genetic predisposition to the disease. An individual with a first-degree relative with gluten allergy has a 10 percent chance of also developing it. When one of identical twins have gluten allergy, the other has a 70-75 percent chance of also developing the disease. Gluten allergy is often associated with other conditions; for instance, people suffering from thyroid problems, insulin-dependent diabetes, or ulcerative colitis, having a higher risk of developing an intolerance to gluten.
The severity and the nature of symptoms varies greatly and may include impaired growth among infants, diarrhea or constipation, abdominal pain, flatulence, mouth ulcers, dermatitis herpetiformis (itchy blisters, usually on the elbows and knees), vitamin and mineral deficiency(especially calcium and iron),fatigue, anemia, or weight loss.
The condition is often diagnosed in childhood when cereals are introduced into the diet, although it can develop at any age. Half of adults with gluten allergy do not present with any bowel symptoms, which leads to a high level of misdiagnosis by physicians. Blood tests are useful as screening tests for anemia and mineral and nutrient deficiency. Numerous blood tests testing for elevated levels of gluten allergy-related antibodies have also been developed in recent years, including anti-gliadin and anti-endomysial antibody assays. The only reliable test for gluten allergy however remains an intestinal biopsy, performed when the patient is on a normal gluten-containing diet.
The first line defense against gluten allergy is an adherence to a strict, life-long gluten-free diet. Foods containing wheat, rye or barley should be replaced by non-gluten food such as rice, millet, or maize. Mineral and vitamin supplements are often added to the diet to reduce the risk of micronutrient deficiencies. Gluten-free products, such as gluten-free flour, breads, biscuits and pasta, are becoming more abundant and more easily available. A gluten-free diet usually results in improvement, or even disappearance, of the damage to the lining of the bowel. The damage will however recur when gluten is re-introduced into the diet. Because gluten-free food tends to be low in fiber, constipation may occur in some people but this problem is usually countered by the intake of plenty of fruit and vegetables. In rare cases, patients with severe gluten allergy may also require medication, such as steroids, to suppress the immune system.
If left untreated, gluten allergy may lead to anemia, bone disease, such as osteoporosis, and some forms of cancer, in particular non-Hodgkin's lymphoma. Recent studies have shown that the long-term mortality rate among gluten allergy patients is twice as high as the general population. The main cause of death was non-Hodgkin lymphoma. Long delays between the onset of symptoms and diagnosis by a physician significantly increased the mortality risk. For instance, a 10-year or longer delay in diagnosis increased the risk of death by more than three times in people with severe gluten allergy.
The key to managing gluten allergy effectively and avoiding the long-term health consequences of the disease lie in early diagnosis and initiation of a strict gluten-free diet as soon as possible.
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Last updated on: 27/08/2010
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