Celiac Disease

Adverse Reaction to Wheat (ARF)

Another recent addition to wheat sensitivity beyond Celiac disease, DH , gluten, wheat allergy & non- celiac wheat sensitivity is called adverse reaction to wheat.

In industrialized nations such as the United States, the United Kingdom, and Germany, approximately 20% of the population has been reported to experience Adverse Reactions to Food (ARF) with wheat, nuts, fruits, and milk among the most common triggers . Most ARF are not mediated by the immune system, such as lactose intolerance which is the most common ARF worldwide . ARF may result in both gastrointestinal symptoms and/or extra-intestinal symp- toms. Gastrointestinal food allergies (an IgE immune response) do exist in both children and adults but the majority of symptoms from ARF are due to non-immunologic reactions to foods . Although immunoglobulin testing of antibodies to food proteins (IgE, IgG, IgA, IgM) is of clinical value in identifying an adverse reaction, exclusive use of such testing may be limiting.

ARF is a term which highlights the fact that wheat gluten may not be the only culprit in triggering reactions . At this point, research. suggests that many other components other than gluten could be triggering the immune reaction . Gluten is a clear culprit in the case of celiac disease. Other potential culprits include amylase-trypsin inhibitors (ATIs), wheat germ agglutinin WGA, and fructans (found in FODMAPs). Each of these contain gluten, but gluten may not be the cause of the syndrome.


1: Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders D, Cellier C, Mulder CJ, Lundin KAE. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 2019. Doi: 10.1177/2050640619844125.

2: Uhde, et al., (2016). Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease. BMJ Journals, 65(12), 1930-1937. doi:10.1136/gutjnl-2016- 311964
(http://gut.bmj.com/content/early/2016/07/21/gutjnl-2016- 311964.full)