What is gluten/wheat sensitivity?

Since other components of wheat - such as amylase-trypsin inhibitors (ATIs) or fermentable oligo-, di-, monosaccharides and polyols ( FODMAPs ) can cause similar symptoms, the term non-coeliac wheat sensitivity (NCWS) is increasingly being used in specialist literature. This is considered more precise than non-coeliac gluten sensitivity (NCGS), as it takes into account the variety of potential triggers.

All three grain-related disorders - gluten/wheat sensitivity, coeliac disease and wheat allergy - have similar symptoms and can therefore be easily confused. However, they differ significantly in their pathogenesis and reaction mechanisms:

Coeliac disease is an autoimmune disease in which the consumption of gluten causes chronic inflammation of the small intestine mucosa. Clinical findings include the presence of autoantibodies such as anti-transglutaminase and histological changes that can be classified according to the Marsh classification. Typical symptoms include abdominal pain, wind, bloating, diarrhoea/ constipation and nausea/ vomiting. However extra-intestinal symptoms are also common.

Wheat allergy is a classic IgE-mediated allergic reaction to wheat components. Clinical findings include elevated levels of wheat-specific IgE antibodies and a positive reaction during skin prick testing with wheat protein.Symptoms usually occur rapidly after consumption and can range from skin reactions to anaphylactic reactions.

Gluten/wheat sensitivity is a diagnosis of exclusion: it is made when both coeliac disease and wheat allergy have been ruled out. After consuming foods containing gluten or wheat, those affected develop symptoms similar to those of coeliac disease patients, but without the typical autoantibodies, without autoimmune comorbidities and usually with no or only very slight changes to the small intestine mucosa (Marsh 0-1).