Differentiating Features Between Celiac Disease, Non-celiac Gluten Sensitivity and Wheat Allergy
| Celiac disease | NCGS | Wheat allergy | |
|---|---|---|---|
| Prevalence | 0.5-2.0% | 0.6-6.0% | 0.4-1.0% in children |
| Age of presentation | Childhood and adulthood | Mostly adulthood (3rd-4th decade) | Mostly childhood (1st decade) |
| Sex | F > M (1.3:1-2:1) | F > M (3:1-5.4:1) | M > F |
| Onset of symptoms after gluten exposure | Weeks-years | Hours-days | Minutes-hours |
| Pathogenesis | Autoimmunity (adaptive immunity) | Poorly understood, role of both innate and adaptive immunity | Allergic immune response (IgE antibody against wheat proteins) |
| Clinical featuresIntestinal | Chronic diarrhea, abdominal pain, bloating | Diarrhea, abdominal pain, bloating | Less often |
| Extra-intestinal | Anemia Osteoporosis Neurological symptoms (ataxia, peripheral neuropathy) Growth retardation |
Tiredness Lack of well-being, headache, foggy mind, fatigue Numbness of limbs Joint/muscle pain Fainting Oral/tongue lesions |
More often Skin rashes urticaria Angioedema, asthma, cough |
| Serology | IgA anti-tTG Ab IgA anti-EMA IgA anti-DGP Ab |
IgG Anti-gliadin Ab | IgE antibody to wheat protein |
| Gastroduodenoscopy | Scalloping, grooving of duodenal folds | Normal | Normal |
| Histology | Various grades of villous atrophy with crypt hyperplasia | Normal/increased intra-epithelial lymphocytes | Normal |
| Treatment | Gluten-free diet | Gluten free diet | Wheat restriction |
| Spontaneous resolution | No | Not known | 65% by 12 years of age |
NCGS, non-celiac gluten sensitivity; F, female; M, male; Ab, antibody; tTG, tissue transglutaminase; EMA, endomysial antibody; DGP, deamidated gliadin peptide; FODMAP, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.