Optimizing testing for wheat and gluten conditions

Optimizing outcomes for patients with adverse food reactions

Presented by Gary Falcetano, PA-C, AE-C, and Misty Phillips, MLS(ASCP)^cmMB^cm

How can healthcare providers determine true wheat allergies from intolerance or cross-reactivity? How can we reduce the time it takes to identify celiac disease? Watch our continuing education webinar (click on the graphic below) from Lab Week 2025 to explore testing solutions for allergies and autoimmune diseases related to wheat and gluten.

Understanding testing for wheat and gluten conditions

From bread to cosmetics to biodegradable straws, gluten is present in myriad foods and materials in our daily lives.¹ It’s also the cause of allergy and autoimmune disorders. And its source, wheat, is one of the “Big 9” allergens, the most common allergens responsible for 90% of all food allergies.

Wheat and gluten allergies aren’t always very straightforward, however, and there is a spectrum of effects that patients may experience after eating gluten, ranging from sensitivity that isn’t a true allergy all the way to celiac disease, an autoimmune condition. Identifying where patients fall on that spectrum can be challenging — with so much variability in these digestive system issues, clinicians need to use different testing assays, dietary observations and more. 

This Lab Week 2025 on-demand webinar dives into the role of laboratorians in serological testing to explain how this plays a key role in getting to the bottom of gluten-related disorders. Let’s explore some of the latest innovations in diagnostic approaches.

How testing with allergen components improves gluten-related diagnosis

Allergies are diagnosed after correlating the presence of immunoglobulin E antibodies (IgE antibodies) with clinical symptoms. In terms of wheat allergies, blood testing for sensitization to allergen components increases sensitivity and specificity of these IgE blood tests that are a part of that correlation.

Wheat is a plant in the grass family, so patients with sensitization to grasses may show sensitivity to wheat as well but not have a true allergy.² Laboratory tests with allergen components can help sort out cross-reactivity and help identify true allergies.

For example, gliadins are specific gluten proteins that you can test for sensitization to, such as Tri a 19, an Omega-5 gliadin that is considered a marker allergen for clinical wheat allergy and wheat dependent exercise-induced anaphylaxis.³ Another important protein is Tri a 14, a lipid transfer protein that can help distinguish true wheat sensitization versus cross-reactivity with other grasses.⁴ It’s also been implicated in predicting “baker’s asthma,” or sensitization following inhalation of wheat flour.⁴

A key factor in providing these types of diagnostic tests is testing for water- and alcohol-soluble proteins to ensure comprehensiveness. As our experts discussed, some alcohol-soluble proteins may be underrepresented in whole allergen assays, so laboratorians should seek out testing solutions such as ImmunoCAP™ Specific IgE allergen component blood tests that can provide improved sensitivity and specificity for patients with suspected wheat allergy.

The importance of serological testing for celiac disease

Gluten can cause more than allergies or intolerance — it’s also the cause of the autoimmune condition celiac disease. Patients with celiac disease experience gastrointestinal symptoms like bloating and constipation, and they may also have fatigue, headaches and other symptoms.⁵ In the webinar, Misty Phillips noted how patients must be vigilant for cross-contamination in many settings. For example, dining out can run the risk of gluten or wheat cross-contamination from a restaurant’s kitchen, an issue that becomes particularly stressful during travel.

Getting to an accurate diagnosis is therefore critical to improving symptom management and quality of life, especially for children experiencing symptoms of celiac disease. As challenging as celiac may be, it can be managed with a gluten-free diet. This also underscores the importance of diagnostics — patients can be empowered to make dietary changes that bring relief from their symptoms and avoid the need to take medications (which would be ineffective in a case of misdiagnosis anyway).

How do we get to an accurate diagnosis? With three key factors: positive serology, positive biopsy, and remission of symptoms on a gluten-free diet.⁶ For laboratorians, serology testing is their contribution to identifying celiac disease, and autoimmune test assays are the tools they need.

The webinar highlighted that EliA™ autoimmune diagnostic solutions, for example, provide assays with more than high specificity. Mitigating false positives and unnecessary biopsies is extremely important for better patient care, so utilizing testing solutions with the highest specificity is an important differentiator for labs.

All of the EliA assays can be run on the same Phadia™ Laboratory Systems, thereby simplifying lab workflows while delivering the sensitivity and specificity needed to diagnose a complex condition like celiac disease.

Improving patient outcomes with quality testing

Wheat- and gluten-related conditions can be confusing for patients and challenging for clinicians. But with the right testing approaches, healthcare providers can address the spectrum of gluten-related conditions and help provide an improved quality of life for patients. Laboratorians play an important role in getting to the bottom of these questions, and they have the tools available to better identify everything from sensitivity to true allergies to autoimmune conditions. Utilizing Phadia™ Laboratory Systems can cut through the uncertainty and is an important step towards delivering outstanding service to clinicians and better outcomes for patients.