Are Your Symptoms a Gluten Allergy or Something Else?

"Gluten allergy" is not a real medical term. Rather, when people use the term gluten allergy, it's likely they mean one of five different conditions: celiac disease, non-celiac gluten sensitivity, dermatitis herpetiformis, gluten ataxia, or wheat allergy.

While these five conditions share some similarities, their overall symptom profiles are marked by several key differences. With the exception of wheat allergy, none of them are true allergies. Contrary to popular belief, wheat allergy and gluten allergy are not the same thing, either.

This article explains the different sets of symptoms and related issues that are commonly referred to as gluten allergies, along with how to tell them apart.

Celiac Disease

When your healthcare provider hears you say "gluten allergy," they are likely to think first of the autoimmune condition celiac disease.

In celiac disease, the immune system mounts an attack on the small intestine in response to the ingestion of gluten-containing foods.

Untreated celiac disease can lead to villous atrophy, in which the tiny bumps lining your small intestine that absorb dietary nutrients, known as villi, become inflamed. Eventually, the inflamed villi can flatten and even disappear.

When this happens, your body's ability to absorb nutrients from your foods becomes partially or totally impaired—a condition known as malabsorption that results in severe nutrient deficiencies.

Malabsorption is associated with numerous complications, including osteoporosis and fractures resulting from brittle, nutrient-deficient bones. Villous atrophy is also linked to an increased risk of lymphoproliferative disorders, such as lymphoma and leukemia.

Celiac disease symptoms.
Tim Liedtke / Verywell

Celiac disease affects about one in every 133 Americans.

There are many different symptoms potentially caused by celiac disease. Every case is different. In fact, some people don't have any symptoms at all. But there are some symptoms that appear frequently in people ultimately diagnosed with celiac disease, including:

  • Diarrhea and/or constipation
  • Abdominal pain and/or heartburn
  • Bloating
  • Fatigue
  • Brain fog
  • Anemia
  • Joint pain
  • Rashes
  • Depression and/or anxiety

The absence of these symptoms doesn't necessarily mean you can rule out celiac disease. And other people mainly experience neurological symptoms, such as migraines and tingling in their arms and legs. 

Can Celiac Disease Develop Suddenly?

In many cases, people with celiac disease are able to digest gluten for years before suddenly developing symptoms. Celiac disease is best known for causing gastrointestinal symptoms. It can fly under the radar when it causes systemic (affecting multiple body systems) issues, like brain fog, fatigue, anemia, and joint pain. 

Non-Celiac Gluten Sensitivity

Non-celiac gluten sensitivity—a condition that's only been accepted by researchers and clinicians over the past couple of years—causes symptoms that are really similar to those of celiac disease. In fact, it's not possible to tell the two conditions apart without medical testing.

Symptoms you may experience with non-celiac gluten sensitivity include:

  • Diarrhea and/or constipation
  • Heartburn and/or stomach ache
  • Bloating
  • Flatulence
  • Fatigue
  • Brain fog
  • Headaches (including migraine)
  • Rashes and/or eczema

Like those with celiac disease, people with non-celiac gluten sensitivity also report joint pain, anxiety and/or depression, and even numbness in their arms and legs. 

Wheat Allergy

People who have a true allergy to wheat sometimes also experience gastrointestinal symptoms and rashes. However, wheat allergy symptoms are often more "typical" allergy symptoms, such as a runny nose.

Although people occasionally refer to a wheat allergy as a gluten allergy, a true wheat allergy doesn't necessarily involve gluten. It's possible to be allergic to multiple proteins in the wheat plant, and gluten may or may not be one of them.

Symptoms of true wheat allergy include:

  • Nasal congestion
  • Itchy, red, watery eyes
  • Hives and/or itchy rashes
  • Swelling of lips, tongue, and/or face
  • Nausea, vomiting, and/or abdominal pain
  • Diarrhea
  • Difficulty breathing

In some people with wheat allergy, exposure to wheat may trigger anaphylaxis, a potentially life-threatening, systemic allergic reaction. Symptoms of anaphylaxis include coughing, wheezing, rapid or irregular heartbeat, difficulty swallowing, or a large drop in blood pressure. Anaphylaxis is a medical emergency, so if you experience these symptoms, call 911 immediately. 

Dermatitis Herpetiformis

It's not unusual for a true allergic reaction to result in a skin rash. As such, it would make sense to call dermatitis herpetiformis a gluten allergy since it causes a remarkably itchy, persistent rash.

But a dermatitis herpetiformis rash is not the result of a true allergy. Dermatitis herpetiformis, also called Duhring disease, is an autoimmune skin condition in which exposure to gluten causes the body to produce antibodies that mistakenly attack skin tissues.

Symptoms of dermatitis herpetiformis include:

  • Reddened skin
  • Multiple small bumps that look like pimples
  • Itching and burning
  • Purple marks where bumps are healing

Dermatitis herpetiformis can occur anywhere on your body, but the most common locations for this rash are your buttocks, elbows, knees, and on the back of your neck. Also, most people who have dermatitis herpetiformis have celiac disease as well.

What Is the Difference Between Autoimmunity and Allergy?

An allergy occurs when the immune system overreacts to an allergen and attempts to expel it from the body. Autoimmunity occurs when the immune system creates antibodies that mistakenly attack the body's own tissues or organs.

Gluten Ataxia

The last of the potential "gluten allergy" conditions is also the most uncommon: a brain disorder called gluten ataxia.

With gluten ataxia, gluten consumption actually causes your immune system to attack the part of your brain called the cerebellum, eventually resulting in irreversible damage.

Fewer than 10% of people with gluten ataxia have gastrointestinal symptoms. More common symptoms of gluten ataxia include:

  • Problems with walking and your gait
  • Clumsiness and lack of coordination
  • Deterioration of fine motor skills
  • Slurring of speech
  • Difficulty swallowing

Gluten ataxia is progressive. People with this condition may start out with what may seem like a minor balance problem, but can ultimately wind up with significant disability.

How to Tell the Difference

It's clear you can't tell from symptoms alone. You'll need to see your healthcare provider and have some medical testing to determine which of these gluten-related conditions—if any—you might actually have.

If you have gastrointestinal symptoms that may point to celiac disease, you'll likely start with celiac blood tests. If those are positive, your healthcare provider will likely recommend you undergo an endoscopy, a procedure that enables them to look directly at your small intestine and take samples for laboratory examination.

If, on the other hand, your celiac blood tests are negative, then your healthcare provider may consider the possibility of non-celiac gluten sensitivity or another condition such as irritable bowel syndrome, and may recommend tests for gluten sensitivity

Wheat allergy is usually diagnosed with skin prick tests, although your healthcare provider may also use a blood test that looks for specific antibodies to wheat proteins. 

For people with rashes they believe may be dermatitis herpetiformis, the first step is likely a visit to a dermatologist, who may recommend a skin biopsy that checks for deposits of specific antibodies in your rash area. 

And finally, if your symptoms are indicative of gluten ataxia, the path to diagnosis unfortunately isn't straightforward, although there are several tests your neurologist may want to perform. 

Regardless of which of these "gluten allergies" you think you have, your first step should be an appointment with your healthcare provider. They can help you determine what medical testing, if any, you may need.

Summary

"Gluten allergy" is an inexact term commonly used when referring to celiac disease, non-celiac gluten sensitivity, dermatitis herpetiformis, gluten ataxia, or wheat allergy. Some of these conditions, like celiac disease and dermatitis herpetiformis, are closely related. But only one of them—wheat allergy—is a true allergy. Although wheat contains gluten, you can have a wheat allergy without any clinical gluten sensitivity.

If you experience unusual symptoms after consuming gluten, contact your healthcare provider for a diagnosis. You may need special testing to determine the underlying cause.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Jane Anderson
Jane Anderson is a medical journalist and an expert in celiac disease, gluten sensitivity, and the gluten-free diet.