Clinical Nutrition · Dietetic Internship · Topic of the Week

TOTW: Celiac? Allergy? Gluten Intolerance?


Hello all! I finished my rotation at the hospital yesterday, it was a bittersweet moment.  I’ll get to that later though.

One of the many things I learned, or learned more about, in my time in outpatient was celiac and gluten intolerance.  I’m very aware of the fact that there is a difference between the two, but I never really had anyone break it down for me.

Well, when we had another person not show, D spent some time talking to me about the differences.  She gave me a handout from the Gluten Intolerance Group titled “Celiac, Allergy or Non-Celiac Gluten Intolerance: What is the Difference?”  Basically, this handout is really detailed and helpful for someone like me, who already knows a fair amount about the disease and can build off that knowledge. If I was just learning about it, this handout would make me overwhelmed and confused.

It has a lot of good information though, so I will summarize it for you.  I think there is a need for more knowledge about celiac and gluten intolerance out there.  It’s really more than just a fad.

Celiac Disease


Celiac is an immune and autoimmune reaction the protein gluten.  It affects different parts of the body and those reaction may change with each exposure or over time.  It is commonly associated with GI discomfort such as IBS, indigestion, abdominal pain, bloating, nausea, vomiting, and diarrhea.  Along with that it can cause fever, fatigue, constant headaches, migraines, rashes, hives, joint pain, and muscle pain.  A person with celiac disease experiences at least some of these symptoms when they eat a food that contains gluten.

Although all those symptoms can make someone uncomfortable or just feel downright sick, the overall discomfort is really the smallest concern here.  Someone with celiac who eats gluten is actually causing damage to their intestine.  Since this is the case, anyone with celiac has to follow a strict gluten free diet for the rest of their life.

Due to the severity of celiac, it’s important to have it diagnosed with a blood test (called tTG) and an intestinal biopsy.

The good news for celiac is that in a few years there may be drug therapies available that would make celiac disease easier to deal with overall.



A gluten allergy is considered an IgE-mediated allergy. What does that mean?  To put it simply, IgE-mediated allergies are “common allergies” and the IgE is an antibody (a type of protein) that works against certain foods.  Most children with common food allergies, like a wheat allergy, outgrow them, but adults aren’t as lucky and usually keep them for life.  At this point, it’s not clear if the allergy is to wheat or gluten but either way it is a reaction to a protein or chemical in the food.

Allergies have fast reaction times, some are almost immediate and happen in minutes and others take hours.  Unlike celiac, allergies can be potentially deadly depending on what kind of reaction you have to them.  Anaphylaxis is a serious reaction that can include airway swelling, shortness of breath,  low blood pressure, unconsciousness, and in serious cases, death.  Other less serious reactions are similar to those in celiac disease.

A wheat or gluten allergy can be tested for with a RAST test, a skin prick test, or a double blind placebo test.  Like celiac, an allergy also requires a strict gluten free diet.  For some this may be for a lifetime.  It’s not recommended that anyone reintroduce gluten into their diet without an allergy test being done to show the allergen is gone.

Gluten Intolerance 



Not as much is known about non-celiac gluten intolerance.  It is a reaction to proteins, carbohydrates, or other chemicals in the foods and is not an immune or autoimmune response.  It has a really slow reaction time, taking up to several hours, and is difficult to detect.  Unlike the previous two, and intolerance is only an irritant and won’t cause any damage nor death.  The symptoms are similar to celiac as well.

In order to determine if someone has an intolerance, a trial elimination diet is really the best method.  If the symptoms disappear with the elimination of gluten, then that person should avoid or limit the gluten in their diet.


The bottom line here is if you think you have any one of these, you should go see your doctor.  Due to the severity and potential damage of undiagnosed celiac it’s important to know for sure if you have it and not to falsely attribute the symptoms to gluten intolerance.


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