Eczema News – Non-Celiac Gluten Sensitivity

Around end November 2014, I ran a blog series on Children Food Sensitivities, explaining there are various types of gluten-related food sensitivities, namely:

GLUTEN SENSITIVITY

Various types of gluten-related conditions

Celiac disease – Immune system attacks the villi in the esophagus when exposed to gluten protein gliadin, found in wheat, barley, rye, and sometimes oats. This lead to intestinal inflammation, flattening of the villi and long-term damage to the small intestine.

Non-Celiac Gluten Sensitivity (NCGS) – Diagnosis is not straightforward with no proven medical test. It is typically diagnosed after elimination of other similar conditions (for instance, wheat allergy, Irritable Bowel Syndrome) and after observation and further consultations.

Wheat Allergy – Involves an immune Ig-E mediated reaction to the wheat protein, can be diagnosed via allergy test.

It was debatable in 2014 then as to whether non-celiac gluten sensitivity (NCGS) even exists as (i) it is difficult to diagnose NCGS, and (ii) some studies concluded that it is actually sensitivity to FODMAPs rather than NCGS. (Gluten-containing grains are high in FODMAPs (fermentable oligo-, di-, and mono-saccharides and polyols) which are sugars/ carbohydrates that tend to be poorly digested, e.g. frutose.

Almost a year later in 2015, we want to examine (i) whether non-celiac gluten sensitivity (NCGS) is a clinical entity (ie we are sure there’s such a medical condition) and (ii) its impact on eczema or skin rash.

September 2015 Study – Cutaneous Manifestations of Non-Celiac Gluten Sensitivity: Clinical Histological and Immunopathological Features

Methods: 17 patients affected by NCG, median age 36, 76% females, with itchy rash similar to  eczema, psoriasis or dermatitis herpetiformis; wheat allergy and celiac disease tests were carried out to confirm that these 17 patients were not suffering from these.

Finding: Skin improvement noted after a month of gluten-free diet

July 2015 Paper – Non-celiac gluten sensitivity: Time for sifting the grain

In this paper, non-celiac gluten sensitivity is stated as a clinical syndrome characterized by both intestinal and extraintestinal symptoms, which are responsive to gluten (wheat) withdrawal from the diet.

Its estimated prevalence is 3% to 5% and a syndrome from multiple factors.

July 2015 Case study – Gluten Psychosis: Confirmation of a New Clinical Entity

In this case study, a 14-year old girl recovered from psychotic symptoms, after eliminating gluten. Other conditions linked to NCGS included:

  • Gastrointestinal symptoms: Abdominal pain, bloating, diarrhea or constipation
  • Systemic manifestations: “Foggy mind”, depression, headache, fatigue, and leg or arm numbness
  • Neuro-psychiatric disorders: Autism, schizophrenia and depression

June 2015 Study – Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity

From this paper, a diagnosis pathway was suggested to determine if one suffers from NCGS. The blind gluten challenge remains a ‘gold standard’ for diagnosis; if going on a strict gluten free diet, it is maintained for at least 3 weeks to observe if symptoms improve.

Non-Celiac Gluten Sensitivity Diagnosis

NCGS Diagnosis; copyright of World Journal of Gastroenterology, June 2015; 21(23); 7110-7119; Figure 1

June 2015 Study – Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts’ Criteria; The criteria is similar to above, with varying guidelines on the duration of gluten free and introduction of gluten diet.

Various research had linked NCGS to female gender and adult age.

It seemed from recent studies that NCGS remained a syndrome without an easy way of diagnosis. The latest study that noted an association between gluten and skin rash would likely be considered as being on a small scale. However, the possibility of skin rash linked to gluten cannot be dismissed and more collaboration between dermatologist and gastroenterologist would increasingly be seen as more patients suspect gluten as a source of their skin problems.

Update on 17 October 2016 – A new study showed the possible group of proteins found in wheat – amylase-trypsin inhibitors (ATIs) – to trigger an immune response in the gut that can spread to other tissues in the body. From MedicalNewsToday

ATIs only make up a small amount of wheat proteins – around 4 percent – yet the immune response they induce significantly affects the lymph nodes, kidneys, spleen, and brain in some people, causing inflammation. ATIs have also been suggested to exacerbate rheumatoid arthritis, multiple sclerosis (MS), asthma, lupus, and nonalcoholic fatty liver disease, as well as inflammatory bowel disease.

What’s your experience with gluten? Do you think your child has gluten sensitivity? Share in the comments and we can all learn from it!

Children Food Sensitivities – Confusing Gluten

There’s so much about gluten-free these days – it’s an industry in itself and marketing ‘Gluten-Free’ is seen in menus and food packaging. We hear of sports celebrities performing better after cutting gluten and we hear of celebrity moms choosing gluten-free diets for their children. But what is gluten and what happens when you eat it? As the 4th part of this series, today’s post explores the different types of gluten sensitivities.

TOP 5 Facts You Need to Know to Differentiate Your “Gluten Sensitivity Type”!

Gluten refers to the proteins found in wheat, barley, rye and triticale (a cross between wheat and rye). Gluten gives elasticity/stickiness to the dough.

GLUTEN SENSITIVITY

GLUTEN SENSITIVITY TYPE #1 – CELIAC DISEASE (CD)

CD Fact #1: Involves immune system, BUT not IgE-mediated reaction to the gluten.

CD Fact #2: Immune system attacks the villi in the esophagus when exposed to gluten protein gliadin, found in wheat, barley, rye, and sometimes oats. This lead to intestinal inflammation, flattening of the villi and long-term damage to the small intestine. Associated with high intestinal permeability whereby bacteria, antigens and undigested food ‘leaked’ through the gastrointestinal barrier.

CD Fact #3: Symptoms include diarrhea, abdominal bloating/pain/cramps, bone/joint pain, bruises, constipation, depression, failure to thrive for children, mouth sores, infertility/miscarriage, malnutrition, weight loss, chronic fatigue, anemia, blood or fats in stool, nausea, joint pain, tingling on hands/feet, Dermatitis Herpetiformis or no symptom. Related to malabsorption of nutrients due to the intestinal villi being compromised.

CD Fact #4: Diagnosis is straightforward with tests to detect AGA (Antigliadin) and EmA (Andomysium Antibodies). Cutting gluten before testing will affect results. Small intestinal biopsy is an accurate test for celiac disease.

CD Fact #5: Treatment is strict avoidance of gluten in order for the villi to heal. Note that oats can be tainted with gluten and some common medications, vitamin supplements and cosmetic products also contain gluten. Untreated gluten has been linked to intestinal cancer, liver disease, small bowel ulcers and other inflammation-related diseases of the digestive tract, heart, joint and even brain.

GLUTEN SENSITIVITY TYPE #2 – NON-CELIAC GLUTEN SENSITIVITY (NCGS) or GLUTEN INTOLERANCE

NCGS Fact #1: Does not involve immune system and is not celiac disease. However, patients clearly experience discomfort and symptoms after ingesting gluten.

NCGS Fact #2: No intestinal inflammation and not associated with high intestinal permeability, unlike celiac disease.

NCGS Fact #3: Symptoms are gastrointestinal symptoms like abdominal bloating, diarrhea, gas, cramps, headaches and fatigue.

NCGS Fact #4: Diagnosis is not straightforward with no proven medical test. It is typically diagnosed after elimination of other similar conditions (for instance, wheat allergy, Irritable Bowel Syndrome) and after observation and further consultations.

NCGS Fact #5: Treatment is avoidance of gluten ONLY after confirmation of this course of action by doctors. Doctors will eliminate the possibility of celiac disease, wheat allergy or other diseases before advising on treatment for NCGS.

GLUTEN SENSITIVITY TYPE #3 – WHEAT ALLERGY (WA)

WA Fact #1 : Involves an immune Ig-E mediated reaction to the wheat protein

WA Fact #2: The increase in IgE antibodies trigger chemical release that lead to allergic reactions, that can either be manifested via the skin, respiratory or gastrointestinal systems and other behavioral issues.

WA Fact #3: Wheat is one of the common food allergens in children and symptoms include eczema, rhinitis, asthma, urticaria, conjunctivitis, abdominal pain, diarrhea and angiodema. These symptoms could be immediate (swelling or hives) or be delayed, including low weight gain in children. There’s also exercise-induced anaphylaxis to wheat.

WA Fact #4 Diagnosis is via allergy testing.

WA Fact #5: Treatment is avoidance of wheat. There is no need to avoid barley and rye which contains gluten but not wheat.

There is recently studied that people with non-celia gluten sensitivity may actually not be sensitive to gluten, but instead to FODMAPs. FODMAPs stand for fermentable oligo-, di-, and mono-saccharides and polyols, which are sugars, carbohydrates that tend to be poorly digested, e.g. frutose. It could be that gluten-containing grains are high in FODMAPs and thus avoiding gluten makes one who is sensitive to FODMAPs feel better. (see this study conducted as double-blind cross-over trial).

Update on 17 October 2016 – A new study showed the possible group of proteins found in wheat – amylase-trypsin inhibitors (ATIs) – to trigger an immune response in the gut that can spread to other tissues in the body. From MedicalNewsToday

ATIs only make up a small amount of wheat proteins – around 4 percent – yet the immune response they induce significantly affects the lymph nodes, kidneys, spleen, and brain in some people, causing inflammation. ATIs have also been suggested to exacerbate rheumatoid arthritis, multiple sclerosis (MS), asthma, lupus, and nonalcoholic fatty liver disease, as well as inflammatory bowel disease.

Hope this 4-part series clarify! it did for me and I have a clearer picture and better appreciation of the complexities involved in understanding and diagnosing one’s gluten-related (or suspected!) condition.

For other posts in this series, do check out

Allergic, Intolerant or Hyper?

Top 10 Kids’ Food Sensitivities Myths

Outgrowing Food Allergy

Sources:

MedicineNetFODMAP studyMayo ClinicWebMd

Hangout on Baby Food – Fish and Gluten Allergy

Caroline Mili Artiss cooks during OzSupernanny Hangout Eczema Baby Fish

This is the third Food Google Hangout with OzSuperNanny, Angela Jacobsen, and it is one of the Google+ event for Singapore #FoodieWebWeek

Chef Caroline Mili Artiss who is a TV chef with her own cookery show demonstrates live the fish pie recipe from Angela’s bookVivian Pei, Paula and Zurina Byrant and I attended (though I’m sort of hanging out offline cos it didn’t work for me online). Here are my questions answered, plus a background on food allergy.

1. Fish and Gluten 

On allergy, Angela’s suggestion is to keep a food journal. Especially for babies who are too young to be allergy tested (below 6 months – though there are varied opinions on this, check with your doc), keeping a food journal can help to identify suspected foods. On fish, it’s interesting, an extract from my earlier post ‘Will Introducing Fish Early Reduce Eczema

There are six common foods that make up majority of the allergic foods, and fish is one of them (the other five foods are milk, egg, soy, peanuts and wheat). Yet, there were a few studies conducted in Sweden and Norway that indicated a lower rate of eczema for children who started fish in their diets early. In a 2008 study, introduction of fish to babies before 9 month-old showed 24% less likelihood of getting eczema by one year old. In another study, one to two year old who ate fish once a week had 38% less likelihood of eczema. In the journalby American Academy of Pediatrics, late introduction of fish was strongly related to inhalant sensitization. Research had not measured notable reduction in eczema with intake of supplements nor were there differences between eating fish vis-à-vis omega-3 rich fish. It is also observed in countries that typically introduce fish in children’s diet early that there is a lower rate of fish allergy.

On gluten, there are studies that show cutting gluten helps eczema, but there is due to a higher likelihood of eczema patients having gluten sensitivity. If there is no allergy to gluten, then it wouldn’t result in an improvement.

2. Texture of Baby Food

I also asked about the texture of baby food, and the reply was to progress from pureed to mashed to finger food, by age and teeth of child. A quick way to prepare food is to prep the day before (which I hate to do) and Chef Vivian suggested using ingredients that are healthy (canned tuna) or fresh vegetable.

Click here for the video of the Hangout!

Related Posts Plugin for WordPress, Blogger...