Gluten is a protein that's present in wheat and other grains, like barley and rye. Gluten helps dough maintain its shape and gives it an elasticity or a chewy texture. Although it's commonly found in baked goods and pastas containing wheat (or barley or rye) flour, it can also be found in cereals, crackers, and sauces or in unexpected foods such as ice cream, pickles, and hot dogs.
But "a 'gluten allergy' is really a misnomer, because it's really a wheat allergy, and gluten is one of the components," says David Stukus, M.D. assistant professor of pediatrics at Nationwide Children's Hospital in Columbus, Ohio. "A wheat allergy is an immediate onset allergic reaction caused when the body's immune system reacts against wheat proteins, and it usually occurs with every exposure." Wheat is one of the eight most common food allergies; the others are cow's milk, eggs, soy, peanuts, tree nuts, fish, and shellfish; together they account for more than 90 percent of allergic reactions. If your child has an allergy, he'll likely experience immediate and reproducible hives or swelling whenever the food is consumed, says Dr. Stukus.
Sometimes, what you think is a gluten allergy may actually be a gluten sensitivity or gluten intolerance, when your baby has a mild, uncomfortable reaction to foods containing gluten. In most cases, you may notice issues with the digestive system, such as excessive gas, abdominal pain, diarrhea, or constipation.
"With an intolerance, you typically see vomiting, diarrhea, or stomach upset," says Deena Blanchard, M.D., of Premier Pediatrics in New York City. A true gluten allergy would cause hives and possibly bloating, abdominal cramping, diarrhea, or constipation. There are no accurate tests to determine a gluten intolerance or sensitivity. Instead, your doctor will recommend cutting back certain foods. "Most experts recommend a trial elimination diet for at least two weeks to see if symptoms resolve, followed by reintroduction to see if symptoms return," Dr. Stukus says.
An actual wheat allergy doesn't cause chronic digestive issues, but you may notice your child having a combination of itchy hives, swelling, vomiting, difficulty breathing or swallowing, and anaphylaxis (a life-threatening reaction). These signs are usually caused by the body's antibodies reacting to specific foods, and babies may outgrow it as they get older.
"With a true allergy, you'll usually see hives all over the child's body that are very itchy," says Dr. Blanchard. "In more severe reactions, the child will experience lethargy, difficulty breathing, lip or tongue swelling, or profuse vomiting and diarrhea. In most cases, doctors rely on a skin prick test to determine wheat allergies. This involves coating a needle or probe with a drop of wheat allergen, then pricking a baby's arm or back with the needle. A hive or rash around the area of the skin prick is an indication of an allergic reaction.
Going completely gluten-free is no easy task, so before putting your baby on this type of restrictive diet, make sure you ask your doctor whether it's truly necessary.
A more serious reaction to gluten is celiac disease, a chronic autoimmune condition triggered by the ingestion of gluten. This is different from an allergy. "The body attacks itself in many areas but most prominently in the intestines," Dr. Stukus says. The complete removal of gluten from the diet will resolve symptoms. It affects roughly one percent of the population.
Celiac disease can lead to diarrhea, abdominal pain, constipation, poor weight gain, or joint pains and rashes. People with celiac do not experience anaphylactic reactions, Dr. Blanchard says. You may notice bloating, abdominal cramping or pain, and difficulty having bowel movements.
There are a few tests to determine the presence of celiac disease. "The gold standard test is a biopsy of the small intestine to examine the lining of the gut for characteristic changes," says Dr. Stukus. This usually involves an endoscopy, Dr. Blanchard adds. But a blood test, in which blood is withdrawn and analyzed for a high number of antibodies toward a certain allergen, is more commonly recommended because it's simple and readily available.
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