1. March 2003 05:00
A Life Without Bread and Pasta?
GLUTEN ALLERGY, otherwise known as gluten-sensitive enteropathy or coeliac disease, is an immune system disorder. Sufferers react to gluten in foodstuffs which contain wheat, barley and rye. More specifically, the gluten damages the lining of the small intestine causing malabsorption and malnutrition.
The background to the disease
The small intestine is normally lined by villi which enhances the absorption of nutrients. In people with gluten allergy, the immune system attacks the villi leading to partial or complete loss and a subsequent decline in nutrient and vitamin absorption and enzymatic digestion.
Those with a genetic predisposition to the disease carry the biggest risk of contracting it. An individual with an immediate relative who suffers from gluten allergy has a 10 per cent chance of also developing the disease and more significantly, when one identical twin has the condition, the other twin has a 70-75 per cent chance of also developing the disease.
Moreover, gluten allergy is often associated with other conditions such as thyroid problems, insulin-dependent diabetes or ulcerative colitis and sufferers of those diseases having a higher risk of developing gluten intolerance. The nature and severity of symptoms varies greatly and may include impaired growth among infants, diarrhoea 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, anaemia and/or weight loss.
Although the condition is often diagnosed in childhood when cereals are first introduced into the diet, it can develop at any age. However, half of all adults with gluten allergy do not display any bowel symptoms which has lead to a high level of misdiagnosis by physicians. Blood tests are useful as screening tests for anaemia and mineral and nutrient deficiency and in recent years numerous blood testing procedures for elevated levels of gluten allergy-related antibodies have been developed including anti-gliadin and antiendomysial antibody assays. However, despite these recent developments the only reliable test for gluten allergy remains an intestinal biopsy performed when the patient is on a normal gluten-containing diet.
The first line of defence 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 foods such as rice, millet or maize and other gluten-free products such as flour, bread, biscuits and pasta are becoming more common and easily available. In addition, mineral and vitamin supplements are often added to the diet to reduce the risk of micronutrient deficiencies.
A gluten-free diet usually results in the improvement in the damage done to the lining of the bowel although the damage will recur should gluten be re-introduced. However, because gluten-free food tends to be low in fibre, constipation may occur in some cases although this problem is usually countered by the increased intake of fruit and vegetables. In rare cases, patients with severe gluten allergy may also require medication such as steroids to suppress the immune system.
However, should the condition be left untreated, it may ultimately lead to anaemia, 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 with the main cause of death being non-Hodgkin lymphoma. In addition, it has been proved that long delays between the onset of symptoms and diagnosis by a physician significantly increased the mortality risk. For instance, a 10-year delay (or longer) in diagnosis increases the risk of death by more than three times.
In the most basic terms, the key to managing gluten allergy effectively and avoiding the long-term health consequences of the disease, lie in early diagnosis of the condition and the immediate implementation of a strict gluten-free diet.