Do all people with a gluten allergy need to avoid trace amounts of gluten, or can some tolerate trace amounts?
My wife, diagnosed with gluten sensitivity (not sure that “allergy” is correct) tolerates trace amounts.
Anecdotal, to be sure.
It varies, some people can manage a trace amount and others have serious issues - just like with any other allergy. I have one friend who can manage a trace, and had work associate who ended up hospitalized with a flare because of the small amount of crumb on a knife used to cut a bagel.
What is the difference between an allergy and a sensitivity? I thought that if a person was allergic to something, even trace amounts would trigger the symptoms. However, if a person was sensitive (or intolerant) to a food (or product) those symptoms (and their relative severity) presented themselves accordingly as the amount of that product consumed increased. Am I wrong?
AFAI can tell, the mechanism. A sensitivity has certain allergy-like symptoms, but they’re triggered by a different molecular pathway.
Eating certain foods or inhaling certain things (such as the pollen from lilliums) makes me very short of breath, but those same things do not trigger histamine tests - so, not allergies. I also do not get rashes (which are present in all alimentary allergies according to the allergologist - and which are what the allergy test is based on), only the breathing problems.
There is another word (intolerance) for yet another mechanism.
Allergies are mediated by IgE antibodies. Sensitivities are not.
Celiac disease (aka gluten sensitivity) is an autoimmune disease where the body produces IgA antibodies against the enzyme the body produces to digest gluten. The IgA causes inflammation in the intestines where the enzyme is found.
The body only produces this digestive enzyme if it’s needed, so the solution to this sensitivity is to avoid gluten. No gluten, no enzyme to digest gluten, no autoantibodies attacking the the enzyme in the intestine.
Some folks with gluten sensitivity tolerate small amounts of gluten because their body doesn’t produce the enzyme for gluten unless larger amounts of gluten are present. Other folks produce the enzyme in response to very small amounts of gluten.
The above is a gross overgeneralization and the real picture is far more complex, but for our purposes, the above is pretty accurate.
Sometimes the “trace amounts” can be fairly high. My daughter is gluten intolerant, but can tolerate up to about a half a slice of bread once a week, or the equivalent amount over several days.
Maybe.
The thing is, we don’t really know what sort of internal damage could still be going on. That half a slice of bread doesn’t make her throw up or have diarrhea. We have no idea if it’s setting her up for colon cancer, diabetes, slowed growth, fibromyalgia or the host of other conditions more common in celiac patients who don’t follow their gluten free diet. So even knowing that it seems she’s tolerant to a small amount, we try to avoid it completely.
There’s also a phenomenon noted among celiacs: a period of asymptomatic gluten intolerance during puberty. For reasons we don’t at all understand, gluten intolerant kids do sometimes *seem *to “grow out of it” and be able to tolerate gluten in their tweens and teens. Generally the doctor decides they were never celiac to begin with, but had an overreactive mother. But then they hit their mid-20’s and the symptoms return, and their risk for other autoimmune problems and cancer and diabetes and all the rest is elevated. They weren’t feeling sick, but the gluten was still causing harm. http://www.e-celiacs.org/2-Celiac_Disease_in_Children.htm