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Wheat allergies

The classic form of wheat allergy usually occurs as celiac disease (derived from Greek word koiliakós, "abdominal"). Patients with celiac disease develop loose stools and abdominal cramps when they ingest wheat. The active substance that causes this reaction is gluten, which is the protein of wheat. Other substances in rye, barley, and perhaps oats cause the same reaction in patients with celiac disease. When patients with celiac disease stop eating gluten their symptoms resolve, usually completely and immediately. These patients, usually children, are instructed to continue a strict gluten-free diet for life. There are specialized grocery stores, or sections of grocery stores with gluten-free foods, such as rice bread and rice pasta.

The relationship of celiac disease to ataxia has been known for several decades. Patients with celiac disease may develop cerebellar ataxia and their symptoms and findings cannot be distinguished from patients with inherited ataxia. The cerebellar ataxia in celiac disease does not seem to be the result of poor absorption of nutrients. Celiac disease patients do develop deficiencies in essential nutrients because the inflammation of the lining of the gut tissue prevents the absorption of nutrients and vitamins. Deficiency of such nutrients and vitamins is not the cause for ataxia, but it seems that the allergy to wheat is responsible for ataxia. This is believed to be due to an immune reaction of the human body to wheat protein which inadvertently damages the cerebellum.

Recent research has shown that a person does not have to have the classic symptoms of celiac disease to develop ataxia. An individual may have ataxia symptoms initially and later test positive for celiac disease. One test for wheat allergy is to detect gliadin antibodies, which are proteins in the blood that react with gluten components. Gliadins are components of gluten and are the targets for these antibodies. If the gliadin antibodies are high, doctors conduct further tests to confirm celiac disease. These tests include more specific blood tests or a biopsy, in which an endoscope is used to remove a small piece of tissue from the gut to be examined under the microscope. This often shows specific inflammation of the lining of the gut that helps to diagnose celiac disease. More recent research, however, shows that patients may have ataxia without gut abnormalities. Studies have also shown that people with hereditary ataxia may have high gliadin antibodies. It is not clear whether gliadin antibodies in hereditary ataxia contribute to the ataxia syndrome or make it worse. A strict gluten-free diet is recommended for people who have high gliadin antibodies and ataxia. The hope is that the antibodies are causing the cerebellar ataxia or contributing to ataxia caused by other factors. Because a gluten-free diet is a safe endeavor, trying the diet is risk-free. Before beginning this type of diet, consultation with a dietitian is necessary to learn about the types of foods that contain gluten. For patients with celiac disease, it is easy to follow the strict diet because ingesting gluten-contaminated foods leads to stomach pain, cramps, and/or diarrhea. However, these symptoms do not always occur in ataxia with wheat allergy. Usually a trial of the diet is recommended for at least six months, before reevaluation and possible continuation of the diet. The gluten-free diet requires great commitment by patients and their families.

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