Die 3 wichtigsten Krankheitsbilder einer Getreideunverträglichkeit stellen die Zöliakie,
Getreideallergie und Nicht-Zöliakie-Nicht-Weizenallergie-Weizensensitivität (NZNWWS)
dar. Dieser Beitrag grenzt diese voneinander ab, zeigt Beschwerden auf und stellt
jeweils die differenzierte Diagnostik sowie Ernährungstherapie vor.
Abstract
Glutensensitivity represents celiac disease, wheat allergy and non-celiac glutensensitivity
(NCGS). Gastrointestinal complaints, e. g. abdominal pain, diarrhea, obstipation,
flatulence, nausea and vomiting, as well as extra intestinal problems, e. g. headache,
muscle and joint pain, fatigue or skin disorders, are common symptoms in these diseases.
A correct diagnosis is mandatory for an appropriate individually adapted therapy.
Celiac disease is triggered by gluten from wheat, rye and barley, as well as related
cereals e. g. spelt, Einkorn or Emmer. In genetically predisposed individuals dietary
gluten ingestion causes an activation of the immune system and the destruction of
the intestinal mucosa that results in a generalized nutrient malabsorption and -digestion.
For diagnosis the celiac specific IgA anti-transglutaminase 2/IgA anti-endomysium
antibodies are determined and mucosal damage is evaluated according Marsh-Oberhuber
criteria. In case of reduced serum IgA the detection of IgG antibodies against transglutaminase
2 is recommended. A lifelong strict glutenfree diet is the only available therapy.
Cereal allergy represents different forms. The respiratory wheat allergy is mainly
caused by inhalation of cereal flour, contact urticaria by contact with wheat, and
gastrointestinal complaints after oral food intake. Both, IgE triggered immediate
hypersensitivity reactions and T cell induced late-phase or delayed-type hypersensitivity
reactions may cause clinical symptoms. Several cereal components were identified as
triggers for allergy and are able to induce cross reactions with other cereal proteins
or inhaled substances. The diagnosis for immediate hypersensitivity response is based
on a skin-prick-test and determination of total IgE and specific IgE against cereal
proteins. Since wheat is the most frequently cultivated and processed cereal, wheat
allergy possesses high therapeutic relevance. Patients with wheat allergy must avoid
wheat products. However, rye or barley is well tolerated in most patients.
Patients with NCGS complain about intestinal and extra intestinal symptoms soon after
consumption of wheat or other gluten containing products. Besides of gluten other
wheat components, like amylase-trypsin-inhibitor or FODMAPs, are discussed for disease
trigger. The diagnosis of NCGS is done by exclusion of other diseases and improvement
of symptoms under glutenfree diet. The therapy is based on a glutenfree diet that
can be less restrictive after some weeks.
Schlüsselwörter Weizenunverträglichkeit - Zöliakie - Weizenallergie - Weizensensitivität - Gluten
Keywords gluten sensitivity - wheat sensitivity - celiac disease - wheat allergy - gluten
