Abstract

Coeliac disease is an autoimmune disorder which can develop at any time throughout life. In susceptible individuals, eating gluten, a protein in wheat and related grains, causes damage to the small intestine. Currently, testing for coeliac disease is recommended for individuals at high-risk or presenting symptoms; however it is underdiagnosed due to the diverse clinical presentation. Following a gluten-free diet is currently the only effective treatment. The prescribed gluten-free diet should be monitored, with dietary assessment and support from a trained dietitian. Food labelling helps people with coeliac disease identify ‘gluten free’ or ‘very low gluten’ foods. Research is exploring alternative treatments, and whether the timing and amount of gluten consumed during infancy can be altered for the prevention of coeliac disease.

COELIAC DISEASE AND OTHER ADVERSE REACTIONS TO FOOD

For a small percentage of people, specific foods or components of food may cause non-toxic adverse reactions, typically classified as food allergy (immune-mediated) or food intolerance (non immune-mediated) (1).
A food allergy occurs when an allergen (usually a protein in the offending food, which in the majority of people will not produce an adverse reaction) sets off a chain of reproducible reactions involving the immune system. Allergic reactions can be classified based on the mechanisms involved, i.e. they can be either IgE (immunoglobulin E antibodies) or non-IgE mediated reactions. The former are usually immediate; whereas, the latter are usually more delayed (1).
Food intolerances do not involve the immune system. Food intolerant reactions may be categorised as enzymatic (due to an enzyme deficiency such as lactase which is needed to digest lactose in milk), pharmacological (due to vasoactive amines, e.g. histamine, which may produce pharmacological effects in intolerant patients) or undefined (intolerance resulting from non-identified mechanisms). Some food aversions may mimic ...