When Wheat Matters: Allergy, Celiac Disease, and Intolerances

Wheat allergy, celiac disease, and non-specific gluten intolerance all share overlapping gastrointestinal symptoms that can confound primary care diagnosis. This episode addresses the core diagnostic challenge of distinguishing IgE-mediated wheat allergy (including ω-5 gliadin–associated wheat-dependent exercise-induced anaphylaxis) from celiac disease and non-celiac gluten intolerance. We cover epidemiology, clinical presentations and timing of IgE reactions, component-resolved diagnostics, serologic algorithms for celiac disease, when to refer for biopsy, and management implications including gluten-free diet counseling and emergency planning for anaphylaxis. Practical takeaways emphasize improving diagnostic yield in primary care, appropriate use of specific IgE testing, and when specialist referral is necessary. References and resources: https://www.thermofisher.com/phadia/us/en/resources/immunocast/wheat-allergy-celiac-differential-diagnosis.html?cid=0ct_3pc_05032024_9SGOV4