If you know someone who can’t eat wheat, you may wonder whether they have celiac disease or a wheat allergy. These two conditions are alike in some ways — they both involve a sensitivity to wheat, are related to the body’s immune system reactions, and can run in families. However, celiac disease and wheat allergies are quite different. Here are some details on what sets them apart.

1. Celiac Disease Is an Autoimmune Disease

Gluten is a protein found in wheat, barley, and rye. People with celiac disease have a harmful immune response to gluten. Their bodies mistakenly see gluten as a dangerous invader. When people with celiac disease eat gluten, their immune system attacks their small intestines. Over time, this causes lasting damage to their digestive system, affecting their ability to absorb nutrients and causing symptoms like diarrhea and bloating.

Studies show that having one autoimmune disorder makes you more likely to develop another one. If you’re diagnosed with celiac disease later in life, it raises the risk of additional autoimmune conditions.

2. Wheat Allergy Is a Food Allergy

Wheat allergies are also a type of immune system response. But unlike celiac disease, it’s an allergic reaction, not an autoimmune one. If your doctor thinks you may have celiac disease, you might need a blood test to check for tissue transglutaminase immunoglobulin (Ig) A antibodies. If you have celiac disease and eat gluten, your body makes these antibodies, which can cause harmful inflammation in your small intestine.

During an allergic reaction to wheat, the immune system makes a specific type of antibody called IgE. These bind to various wheat proteins (not just gluten), causing the reaction.

3. Different Age Groups Are Affected

There’s no cure for celiac disease or wheat allergies. Instead, people with these conditions need to manage them by adjusting their lifestyles. Getting diagnosed is the first step toward improving your health.

Unfortunately, many people are diagnosed with celiac disease after having had it for several years. Sometimes, they don’t get diagnosed at all. It’s estimated that two-thirds of people with celiac disease go undiagnosed. Most people are diagnosed with celiac disease between the ages of 40 and 60 years old.

However, most people with wheat allergies find out early in life and typically outgrow them by the time they’re adults. Two out of 3 children with a wheat allergy will outgrow it by age 12.

Unfortunately, celiac disease is a lifelong condition. It’s not something people outgrow.

4. The Symptoms Aren’t the Same

An allergic reaction to wheat can cause anything from rashes to digestive problems and breathing trouble. The symptoms of celiac disease are usually more focused on the gastrointestinal tract, although complications can affect other parts of the body over time.

Celiac disease symptoms usually include:

• Abdominal pain
• Bloating
• Diarrhea or constipation
• Fatigue
• Gas
• Nausea and vomiting
• Stomach cramps
• Weight loss

Adults with celiac disease may end up with additional problems from not absorbing nutrients well, such as iron-deficiency anemia and osteoporosis, a condition in which bones become weak and brittle. They may also develop a skin condition called dermatitis herpetiformis, which is an itchy rash that blisters.

Children with celiac disease can also have issues related to malabsorption. They may not grow as tall, and puberty may be delayed. In addition, celiac disease raises a child’s chances of neurological issues, including attention deficit/hyperactivity disorder (ADHD), learning disabilities, and seizures.

Wheat allergies can cause similar symptoms, like nausea and vomiting. Other symptoms of a wheat allergy may include:

• Asthma attacks or wheezing
• Headaches
• Hives (itchy rash)
• Sneezing
• Stuffy or runny nose

The most dangerous symptom of a wheat allergy is anaphylaxis. During anaphylaxis, the airways swell, which causes trouble breathing. Anaphylaxis is life-threatening and requires immediate medical attention. People who are at risk of anaphylaxis may carry an epinephrine auto-injector to reverse breathing problems.

5. They’re Diagnosed Using Different Tests

If you notice that wheat upsets your stomach, your doctor can run various tests to determine if celiac disease or a wheat allergy is to blame. The types of tests used to diagnose celiac disease include:

• Antibody test — A blood test can show if you have IgA antibodies that are associated with celiac disease.
• Biopsy — A sample of your small intestines can be sent to the lab and examined for damage that looks like celiac disease.
• Genetic test — Blood tests can help rule out celiac disease based on your DNA.

To diagnose a wheat allergy, recommended tests may include:

• Antibody test — A blood test can be ordered to look for IgE antibodies in response to wheat.
• Skin-prick test — Wheat proteins are introduced into the outer layer of the skin through a small prick to observe for any reaction, such as swelling.
• Oral food challenge — In the doctor’s office, an allergist gives you small amounts of wheat and watches for a reaction.

If you’re concerned about how your body responds to wheat products, ask for a referral to an allergist or gastroenterologist. These specialists can recommend the proper tests to figure out what’s causing the problem.

6. Treatment Options Differ

The only way to manage celiac disease is to follow a strict gluten-free diet. In addition to wheat, other grains contain gluten, including barley, bulgur, graham flour, rye, and a handful of others. Gluten is also commonly processed in the same facility as other food products, leaving the possibility for cross-contamination. A registered dietitian nutritionist can help you learn how to identify which foods and other products may contain gluten.

If you’re allergic to wheat, you’ll need to stay away from foods and other products that contain wheat. In addition, medications like antihistamines, corticosteroids, and an epinephrine auto-injector can help control your symptoms and keep you safe from a life-threatening reaction.

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