Coeliac disease

Celiac disease (synonyms: gluten-sensitive or gluten-induced enteropathy, indigenous sprue, non-tropical sprue, rarely also intestinal infantilism, Heubner-Herter disease) is a long-term autoimmune disease caused by gluten intolerance that mainly affects the small intestine. It is not an allergy in the strict sense, but a chronic inflammation of the mucous membrane of the small intestine ­due to hypersensitivity to components of gluten, the gluten protein ­found primarily in grains (seeds) of many cereals. Other organs can also be affected. Gluten intolerance is partly hereditary, cannot currently be treated causally and remains lifelong.

Foods containing gluten cause inflammation of the mucous membrane of the small intestine, often with extensive destruction of the intestinal epithelial cells. As a result, nutrients can only be poorly absorbed and remain largely undigested in the intestine. The symptoms and the severity of the clinical picture can vary greatly, which makes it difficult to recognise. Possible symptoms are weight loss, diarrhoea, vomiting, loss of appetite, fatigue, depression, bleeding tendency (due to vitamin K deficiency) and, in childhood, failure to thrive (slowed physical development); neurological disorders can also occur. Untreated celiac disease increases the risk of non-Hodgkin's lymphoma (a cancer of the lymph nodes) and probably also of carcinomas of the digestive tract. Celiac disease is associated with type 1 diabetes mellitus in five to ten percent of patients. The treatment of celiac disease currently consists exclusively of a gluten-free diet.

Similar symptoms as in celiac disease occur in wheat allergy. As a diagnosis of exclusion, "in the presence of a wheat-dependent clinic and negative serology (for celiac disease-specific antibodies), normal small bowel histology, negative specific IgE (wheat), and negative prick test (wheat), non-celiac nonwheat allergy wheat sensitivity may be suspected after careful exclusion of other diagnoses."

Name origin

Celiac disease is the German equivalent of the Neo-Latin technical term coeliacia. The word derives from the Latin adjective coeliacus, with the basic meaning 'concerning the abdomen', but which is also translated in a further meaning as 'abdominal disease' (purely Latin ventriculosus). The Latin coeliacus in turn goes back to the Greek adjective κοιλιακός koiliakós, German 'suffering from digestion', which derives from κοιλία koilía, German 'abdominal cavity', 'belly', 'abdomen'.

Allergens

The allergens are the gliadins (the alcohol-soluble fraction of gluten) and glutenins. Depending on the type of cereal, these allergens have a different composition due to the evolution of cereals.

• Wheat, spelt (incl. green spelt), khorasan, durum: α-/β/ω-gliadin and glutenins, C-C allergen (baker's asthma), CBP2
• Barley: Hordenine amylase inhibitors IAM1 and CMb (both baker's asthma)
• Oats: Avenin A, E and F
• Rye: Secalinin

No allergens, because gluten-free, are the cereals

• Corn
• Rice
• Millet (also: teff, brown millet and hulled "golden millet")

All pseudocereals are also gluten-free:

• Amaranth
• Buckwheat
• Quinoa

As different types of grain are often processed in the same company, cross-contamination cannot be ruled out. Gluten-free goods are indicated, for example, by the gf logo (crossed-out ear of corn), otherwise usually by the warning "may contain traces of gluten" (see section on EU Regulation).

Symbol for gluten-free foodstuffs; registered trademark at the DPMA