Is it
Coeliac Disease? 

Non-coeliac gluten-related disorders

Even if you have abdominal pain and other issues with digestion after eating foods that contain gluten, you may not have coeliac disease.1 There are other gluten-related disorders that are different to coeliac disease, called non-coeliac gluten sensitivity (NCGS) and wheat allergy.1 The three conditions have similar symptoms but are different:1-3

  • People with wheat allergy have an allergic reaction to wheat
  • People with coeliac disease have an autoimmune response associated with gluten ingestion
  • People with NCGS react badly to eating gluten. However, it is not an allergic or autoimmune reaction

What is the difference between an allergy and an autoimmune condition?4

  • Allergies are considered an overreaction of the body’s immune system to external substances, known as allergens.
  • Autoimmune diseases occur when the immune system mistakenly attacks the body’s own healthy cells and tissues.

Non-coeliac gluten sensitivity (NCGS)

NCGS is a condition that causes symptoms after eating gluten in people who do not have coeliac disease or wheat allergy. NCGS is not an autoimmune condition like coeliac disease.2,5 It is the most common gluten-related condition, affecting up to 13 in 100 people.5

Symptoms

Symptoms of NCGS are similar to those of coeliac disease or inflammatory bowel syndrome (abdominal pain, diarrhoea and bloating), but they can also include:2,3

  • Joint or muscle pain
  • Rash or skin problems
  • Depression
  • Anxiety
  • Tiredness
  • Headaches

These symptoms occur within hours to days after eating foods containing gluten and often improve within hours or a few days if no further gluten is eaten.2,3

Diagnosis

NCGS is diagnosed after:2,5

Tests that rule out coeliac disease or wheat allergy

A reduction in symptoms after cutting gluten out of the diet

Symptoms returning after adding gluten back into the diet

Management

As with coeliac disease, the treatment for NCGS is a gluten-free diet.1,5,6

Wheat allergy

Wheat allergy occurs when the immune system wrongly identifies proteins found in wheat as harmful. It causes similar digestive symptoms to coeliac disease, but as it is not an autoimmune disease, it does not cause permanent damage to the gut.2,6 Wheat allergy is one of the most common food allergies in children, and about 1 in 100 people are affected.6,7

Symptoms

Symptoms of wheat allergy develop within minutes to a few hours after eating foods that contain wheat. Some are similar to coeliac disease (nausea, stomach cramps, diarrhoea), but other symptoms include:2,3

  • Hives
  • Itching
  • Swelling in the mouth, eyes, nose and throat
  • Skin rash
  • Wheezing, sneezing and difficulty breathing
  • Life-threatening allergic reaction (anaphylaxis)

Diagnosis

Wheat allergy is diagnosed after:5-7

Blood tests

An allergy skin test using wheat flour

A food challenge completed in hospital to observe symptoms

Management

Depending on how severe symptoms are, the management of wheat allergy can range from avoiding eating or breathing in wheat only in specific circumstances to complete avoidance of all wheat-containing products. People with anaphylaxis should avoid all wheat-containing products, even if the amount of wheat is small. Medical therapies, such as epinephrine autoinjectors, can be used to treat reactions to wheat when it has been accidentally ingested.8

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  1. Rej A, Aziz I, Sanders D S. Coeliac disease and noncoeliac wheat or gluten sensitivity. J Intern Med 2020;288:537-549
  2. Biesiekierski J R, Iven J. Non-coeliac gluten sensitivity: piecing the puzzle together. United European Gastroenterol J 2015;3:160-165
  3. Størdal K, Kurppa K. Celiac disease, non-celiac wheat sensitivity, wheat allergy - clinical and diagnostic aspects. Semin Immunol 2025;77:101930
  4. Bartůňková J, Kayserová J, Shoenfeld Y. Allergy and autoimmunity: parallels and dissimilarity: the yin and yang of immunopathology. Autoimmun Rev 2009;8:302-308
  5. Akhondi H, Ross A B. Gluten-associated medical problems. StatPearls. StatPearls Publishing, Treasure Island, FL, US, last updated 31 October 2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK538505/
  6. Patel N, Samant H. Wheat allergy. StatPearls. StatPearls Publishing, Treasure Island, FL, US, last updated 25 June 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK536992/
  7. Czaja-Bulsa G, Bulsa M. What do we know now about IgE-mediated wheat allergy in children? Nutrients 2017;9:35
  8. European Academy of Allergy and Clinical Immunology. Molecular Allergology User's Guide 2.0. Available at: https://eaaci-cdn-vod02-prod.azureedge.net/KnowledgeHub/education/books/MAUG_2_20221214_EBOOK.pdf. Accessed March 2025