Gluten seems to be a topic of discussion in almost any article in the news regarding food these days. There are a lot of people avoiding gluten in their diets for many different health benefits. Is it possible that avoiding gluten in our diets could help lessen the effects of eczema? Let’s explore this a little bit more – gluten and eczema – is there a connection?
Let’s start off by defining what exactly gluten is. Gluten is a protein found in grains like wheat, rye and barley. More and more people are determining that they must have a gluten sensitivity or gluten intolerance because of the health benefits they believe they gain when they avoid gluten in their diets. As a result, the gluten-free market has taken off and has grown into a $15 billion industry.
There are the three main medical conditions associated with gluten. They are: Celiac disease, non-Celiac gluten sensitivity, and wheat allergy.
Celiac disease affects less than 1% of the U.S. population. Individuals with Celiac disease have an autoimmune system producing antibodies to gluten protein. There are a range of gastrointestinal (GI) symptoms associated with Celiac disease that include stomachaches, gas, bloating, and diarrhea. Doctors will test for Celiac disease in children who fail to thrive and have typical GI symptoms. In adults and older children, Celiac often carries a characteristic rash called dermatitis herpetiformis. A simple blood test can be done to diagnose Celiac disease. Tissue-transglutaminase antibodies (tTG-IgA) will be positive in 98% of Celiac individuals on a gluten diet. Other tests that can be done to diagnose Celiac disease are the IgA Endomysial antibody test, total serum IgA, and deaminated gliadin peptide.
Non-celiac gluten sensitivity (NCGS) is also simply called gluten sensitivity. Individuals with NCGS test negative for Celiac disease and do not have IgE antibodies to wheat. This condition has only been recognized in the last five years. Individuals with NCGS are diagnosed when they test negative to Celiac tests, when their GI and non-GI symptoms improve on a gluten-free diet, when their symptoms reoccur with gluten re-exposure, and when there is no other explanation. Some believe that NCGS is really a problem with certain carbohydrates called Fodmops. Fodmops stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols sugars. It is believed that fodmops are poorly digested, allowing bacteria to produce more gas from the fodmops, and ultimately resulting in the GI symptoms of gas and abdominal distress.
Wheat allergy is defined as an allergy to any of the hundreds of wheat proteins. People with a wheat allergy typically break out in hives or a rash and can ultimately have difficulty breathing and anaphylaxis. The immediate Type I allergic reaction is due to the IgE antibodies that are produced by wheat. Children may grow out of this allergy but adults are less likely to do so.
Eczema, aka Atopic Dermatitis, is included in the Atopic triad of asthma, hay fever, and eczema. Atopic individuals have an different immune system that is more sensitive to certain triggers and exposures. Eczema affects up to 20% of children and that number has grown in westernized countries like the U.S. and U.K. over the past few years. There has always been the chicken or the egg question with food and eczema. Do food allergies trigger eczema or do individuals with eczema have more food allergies? It must be made clear that foods do not cause eczema but may serve as triggers of eczema. A question has been raised recently as to whether gluten can serve as one of those triggers of eczema. There are limited studies but a 2015 study showed that individuals with NCGS (gluten sensitivity) with skin issues such as eczema improved with a gluten-free diet. Individuals with Celiac disease can have a higher likelihood of skin conditions such as eczema and dermatitis herpetiformis (a very itchy skin rash with bumps and blisters). The eczema in these Celiac individuals has been known to improve with a gluten-free diet.
To recap, there are three medical conditions linked to gluten: Celiac disease, non-Celiac gluten sensitivity, and wheat allergy. If an individual has any concern that he or she may have one of the conditions, testing should be undertaken to diagnose Celiac disease. Do this testing first! Celiac testing is only accurate when there is gluten exposure. If an individual starts to limit gluten exposure before testing is done, the Celiac tests may be falsely negative. Finally, see a GI specialist with expertise in Celiac disease and/or gluten sensitivity to help lead you to the correct diagnosis.
Is there a connection between gluten sensitivity and eczema? It appears so! But be sure and have explicit medical testing to help determine the exact type of sensitivity and course of treatment. If the testing determines you need to limit your gluten intake, chances are you may see an improvement in your eczema symptoms as well.
Bonciolini V et al. Cutaneous Manifestations of Non-Celiac Gluten Sensitivity: Clinical Histological and Immunopathological Features. Nutrients. 2015 Sep 15;7(9):7798-805.
Catassi C. Gluten Sensitivity. Annals of Nutrition and Metabolism. 2015;67 Suppl 2:16-26.
Ciacci C et al. Allergy prevalence in adult celiac disease. Journal of Allergy and Clinical Immunology. 2004 jun;113(6):1199-203.