Gluten is a storage protein found in common grains such as wheat, barley and rye. When your body reacts negatively to the ingestion of this protein, you may have a gluten allergy or intolerance. A more severe form of gluten intolerance called celiac disease also may be the problem. Finding the appropriate health care practitioner to identify the condition is key.
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Primary Care Physician or Internist
Initially, your primary care physician (PCP) or internist can screen you for a gluten allergy. Take to your appointment a list of symptoms and reasons why you suspect gluten. Most PCPs or internists can order the appropriate screening blood tests which may include a celiac disease panel for specific autoimmune antibodies or an IgE antibody test for wheat, the most common gluten-containing grain. These two tests identify different types of gluten reactions in the body--the former an autoimmune process called celiac disease, the latter a classic immune-mediated allergy akin to the well-known and sometimes dangerous peanut allergy. If your doctor does not feel comfortable with your request for testing, ask to be referred to a gastroenterologist or allergist.
Celiac disease, a severe form of gluten intolerance, is formally diagnosed via an endoscopy and positive biopsy of the small intestine revealing damage to the lining. Endoscopy is the use of narrow, flexible lighted tubes with built-in cameras to visualize the interior of the intestinal tract. According to the American College of Gastroenterology, gastroenterologists are recognized nationally as experts in evaluating digestive disorders and have dedicated training in endoscopy and biopsy. If you have positive celiac disease blood tests or if your family doctor suspects the disorder, a gastroenterologist should be enlisted to confirm the diagnosis.
The American College of Allergy, Asthma and Immunology defines an allergist as a physician who specializes in the diagnosis and treatment of asthma and other allergic diseases. Because wheat allergy is another potential form of a gluten allergy, an allergist can aid in diagnosis. Unlike gluten intolerance, where symptoms resolve after the gluten has left your body, this allergy causes your body to attack your intestinal tract, leading to tissue damage. Skin tests may be performed, in which tiny drops of purified extracts for wheat proteins are pricked onto your skin's surface. After 15 minutes, a doctor or nurse observes your skin for signs of allergic reactions, which may look like red, inflamed bumps. Blood testing for IgE antibodies to wheat may be pursued in addition to or instead of skin tests.
Naturopathic Doctor or Nutritionist
If you are convinced you are reacting to gluten even though your tests are negative, you might have a subset of gluten allergy that doesn't fit neatly into either category of celiac disease or wheat allergy. The Gluten Intolerance Group of North America differentiates gluten intolerance/sensitivity from celiac disease as experiencing distress when eating gluten-containing products and showing improvement when following a gluten-free diet while having negative blood and biopsy testing. A naturopathic doctor or nutritionist is trained extensively in nutrition and identifying food intolerance through the use of an elimination diet or specialized testing.