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Celiac Disease, Refractory Sprue, Gluten Intolerance & Wheat Allergies?

Posted Sep 22 2008 10:17am

As the Director of Programming & Communications for the National Foundation for Celiac Awareness, I get the same question several times a day: what is the difference between celiac disease, refractory sprue, gluten intolerance and a wheat allergy.

Last week, I had the privilege of working with Dr. Daniel Leffler from The Celiac Center at Beth Israel Deaconess Medical Center on the Gluten in Medications Educational Session. During his presentation, he gave a very clear and concise explanation of all four that I wanted to share. Read the following definitions closely. There are subtle but very important differences between each of the four. Dr. Leffler's definitions are italicized. My comments are below his.

1. Celiac Disease:
A heightened immune responsiveness to gluten leading to autoimmune intestinal damage often with systemic manifestations.

This means that a person with celiac disease will actually experience an autoimmune response that will result in damage to the villi in the small intestines. This is what leads to malabsorption of nutrients in food and causes a myriad of symptoms such as stomach aches, diarrhea, headaches, skin irritation, pregnancy complications, failure to thrive, gas, constipation, etc.

2. Refractory Celiac Sprue:
Celiac disease that does not respond to gluten withdrawal.

Patients who are diagnosed with refractory sprue may have experienced some improvement with a gluten-free diet, but then relapse. Recent studies suggest that development of refractory sprue represents a "transition state to intestinal lymphoma." Physicians are unsure about the prevalence of refractory sprue and are working to develop therapeutic guidelines for the disease.

3.Gluten Intolerance:
Functional symptoms related to gluten exposure without an immune response/intestinal damage

Gluten intolerance is not celiac disease, rather it is when patients experience symptoms after eating gluten. There is no autoimmune response and no damage caused to the intestines.

4. Wheat Allergy:
Adverse reactions involving IgE antibodies to one or more proteins found in wheat  (No antibodies to self!)

Wheat is considered one of the eight most common allergens in food. A person with a wheat allergy  typically experiences symptoms within a few minutes to hours of consuming wheat. Symptoms can be mild or severe and generally include congestion, skin reaction and digestive problems, but rarely lead to an anaphylactic reaction.

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