Well, I was in town yesterday and saw that a new Gourmet Burger Kitchen (GBK) was opening soon and thought about my recent experience. Not so long ago, I went out to eat at GBK in London. It’s super lovely whenever I visit my sister, brother-in-law and their adorable babies – if my sister’s not making a big effort on the home-made gluten-free meals and snacks, she’s going all out to make sure we go somewhere that I feel completely safe. My niece has been aware from the age of around 2 that her (favourite) aunty (i.e. me) is a coeliac and must adhere to a gluten-free diet. I am so proud of her for this. When I overhear her saying to other children or adults “my aunty can’t eat that because it’s not gluten-free,” I almost want to burst out in happy tears! #ProudAunty! On the one hand, there’s a toddler who understands that certain foods make me very poorly and on the other, are some adults who find it ever so difficult to comprehend. Although, I recently took her to a vegan fair (she’s 4 now!) and she thought the food looked pretty but didn’t like the taste of her magical cupcake
Anyhoo, back to the reason as to why I’m writing. I asked the staff for the gluten-free menu and it was quite impressive as I found a few things that I could order. Upon ordering, the lady asked whether I am ordering gluten-free due to an allergy or intolerance. I’ve never been asked this question before when eating out, and it made me wonder whether I should let her know that it was neither. I’ve always known that coeliac disease is an autoimmune disease and not an allergy. Still, in the heat of the moment, I categorised it an allergy. I am guilty. I feel that it makes it easier for people to understand; people take more care when preparing my meals; and people are always in a rush – I feel as if they don’t have the time to listen anymore. Just saying it out aloud that I sometimes haven’t been able to explain coeliac disease as well as I’d like to; that I try to make it easier for people to process by saying it is an allergy; that I feel people haven’t got the time to listen, makes me sound as if I intentionally opt to take the easy way out. It makes me sound as rushed as them. It makes me sound as if I can’t be bothered to explain and as if I don’t take my own condition seriously. But that’s far from the truth. And anyway, haven’t we all made a mistake similar to this at some point?
I understand that it is wrong on so many levels and as of that day, I promised myself that I wouldn’t class coeliac as an allergy just to make it easier for people to understand. I will not feed people’s ignorance. Instead, I would utilise every opportunity to raise awareness of not only our condition, but the seriousness of it. This is the least I can do for us.
So, how is coeliac disease different from an allergy?
Well, there are some major differences:
- The antibodies involved are different. Allergies are IgE mediated whereas coeliac disease is IgA mediated (see my not so artistic diagram below).
- In an allergic reaction, the presence of the allergen leads to an immune response whereby IgE antibodies bind to and attack the allergen, releasing chemicals (e.g. histamine) that lead to symptoms. Whereas coeliac disease is when the presence of gluten in the gut leads to an immune response whereby IgA antibodies attack the lining of the small intestine and over time, the microvilli lining the gut becomes damaged, which leads to symptoms.
- Because there are chemicals produced in an allergic reaction, there are certain drugs that can be used to relieve the sufferer of symptoms (e.g. antihistamines). However, in coeliac disease, the damage caused to the lining of the gut takes a longer time to heal thus it takes longer to relive sufferer of symptoms in comparison to an allergic reaction.
- Symptoms in an allergic reaction are a direct result of the reaction between allergen and antibody and the dilating effect that the chemicals have on blood vessels and possibly other organs. Symptoms can include diarrhoea, vomiting, nausea, swelling of lips/tongue/face, coughing, wheezing and stomach pain. In the more severe cases, the blood vessels in the entire body dilate (anaphylaxis) and if left untreated, the sufferer may go in to an anaphylactic shock, which can be fatal. Symptoms in coeliac disease are a result of the damage caused to the lining of the gut, leading to malabsorption of nutrients from foods thus causing symptoms such as anaemia, tiredness, hair loss (alopecia), depression, persistent nausea, vomiting, diarrhoea, cramping and vitamin deficiencies.
Allergens can be substances in for example food, environment (e.g. pollen and dust) or drugs (e.g. penicillin). There are 14 food allergens which are: 1) cereals containing gluten; 2) crustaceans; 3) eggs; 4) fish; 5) peanuts; 6) soybeans; 7) milk; 8) nuts; 9) celery; 10) mustard; 11) sesame seeds; 12) sulphites/sulphur dioxide; 13) lupin; 14) molluscs.
Antibodies are immune proteins that are released as a response to a foreign substance (antigen) entering the body. They target and bind specifically to foreign substances, to attack them. There are various different types – IgA, IgD, IgE, IgG and IgM; each targeting different types of substances, each of differing size and present in differing amounts in different parts of the body.
Autoimmune disease is when the immune response attacks the body’s own cells rather than the foreign substance.
Immune system is the body’s inbuilt system to fight off foreign substances in order to prevent disease and infection.
Intolerance is when the body reacts to certain substances in a non-immune related reaction however; the sufferer may be able to tolerate small amounts of the allergen, depending on the severity of intolerance. When the problematic substance is food-related, the body may be unable to digest the food properly as in lactose intolerance, which is the most common food-related intolerance. Here, the body has insufficient amounts of the lactase enzyme to digest lactose, a sugar found in most milk and dairy products, leading to symptoms after consumption.
Microvilli are hair-like projections on the villi (finger-like projections of the lining of the small intestine) that aims to increase the surface area of the small intestine thus enabling effective and efficient absorption of nutrients from foods.
Hopefully this has clarified a few things about the different terms and left you feeling more confident about differentiating. I’ve taken the decision of not categorising coeliac disease as an allergy. If you haven’t already, will you help? Let’s do it for ourselves. Let’s do it for the future of our little growing community 🙂