Gluten Allergy Rash

One of the more confusing areas of researching a gluten allergy is whether or not it can manifest as a gluten allergy rash. To understand why this is more complicated than a simple allergic reaction and to understand whether or not gluten can trigger a rash at all, it’s important to understand the difference between an allergy and an autoimmune disease, as well as the different conditions that fall under the non-technical umbrella term gluten allergy.

Wheat Allergy Rash or Celiac Disease Symptoms?

While the term gluten allergy is widely used to describe a variety of symptoms, it is not a meaningful or accurate term by itself. You may suffer from a wheat allergy, celiac disease or non-celiac gluten sensitivity (NCGS), but a gluten allergy is not an available diagnosis. Instead, gluten allergy is often used as a blanket term for these three other conditions.

In addition, a gluten skin rash might be a manifestation of an allergy or an autoimmune response that involves some kind of gluten intolerance not diagnosed as celiac disease or a wheat allergy.

To understand how these conditions are separate, differentiate them by how quickly symptoms manifest after exposure. An allergy is a type 1 hypersensitivity. This means you will react either immediately or almost immediately after exposure. It also involves IgE (Immunoglobulin E) rather than the antibodies present with diagnosed celiac disease symptoms.

Celiac disease is an autoimmune disease with a delayed immune response; celiac disease is not a food allergy. In addition, many skin manifestations of gluten intolerance can be delayed and do not involve IgE, thus they are not food allergies either. Most of them, in facts, are more autoimmune in nature.

Many people assume that if you are reacting to something you ate, then you are having an allergic reaction. It isn’t that simple, and it is important to understand how an autoimmune disease is different from an allergy because you won’t always have an immediate reaction to something that your body treats as toxic.

So keep in mind: what many people refer to as a gluten skin rash is often not an allergic reaction.

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Dermatitis Herpetiformis and Linear IgA Disease

The most common rash associated with gluten intolerance is dermatitis herpetiformis (also known as Duhring’s disease). Dermatitis herpetiformis manifests through pinkish to redish blisters that occur most often on the outside of joints (knees and elbows) and from the back of the neck down to the buttocks along the spine. This kind of rash most often begins with a strong itch before the rash even appears, and when it does appear it forms small, watery blisters.

A skilled and experienced dermatologist can diagnose dermatitis herpetiformis with a small biopsy of the skin adjacent to the rash. When a lab examines this sample, they may find IgA antibody deposits, which indicate an autoimmune reaction to the consumption of gluten. You can test negative for both wheat allergy symptoms and celiac disease but still test positive for dermatitis herpetiformis, so don’t make any assumptions if your doctor has previously ruled out celiac disease or a wheat allergy as the cause of your rash.

The reason I mentioned that a skilled and experienced dermatologist needs to take the biopsy is that if the sample is not taken correctly and from the right location, dermatitis herpetiformis can be misdiagnosed as linear IgA disease. This is a different autoimmune disease that doesn’t have as close a relationship with gluten. While about 90% of dermatitis herpetiformis cases are a result of a gluten intolerance, less than 20% of linear IgA disease cases are the result of a response to gluten.

Dermatitis herpetiformis and linear IgA disease look and feel very similar, so accurate lab work is necessary to differentiate these two skin rashes.

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Eczema, Psoriasis, and Urticaria

These are three different skin conditions many people relate to gluten, however they are not all the same thing and their relationship to gluten and wheat is still being researched and determined.

Psoriasis can manifest as a kind of skin plaque instead of a blistering rash, and it often involves pain separate from the desire to scratch.

There is little scientific evidence suggesting gluten or celiac disease cause psoriasis, though there is a strong correlation between psoriasis and many other autoimmune diseases, particularly celiac disease. This correlation exists between many different autoimmune diseases. Simply put, if you have one autoimmune disease, you are far more likely to have another autoimmune disease. Such a correlation does not necessarily suggest causation.

Eczema and Urticaria, however, appear to be possible symptoms of a wheat allergy. It’s important to note that they are not always present when a wheat allergy is present and a wheat allergy can be present without eczema or urticaria being present. But because some evidence suggests a relationship between these skin conditions and wheat allergens, if you have been diagnosed with one of them you should talk to your doctor about a possible wheat allergy.

Eczema is a broad term applied to a broad range of dermatitis diagnoses. It may appear differently in different people, but symptoms often include blisters, cracking skin, patches of crusty, dry skin, itchy spots, pinkish skin blotches and skin edema (skin swelling).

Urticaria is basically what most of us call hives. It manifests itself as blotches of swollen, pale red and itchy raised bumps. Most cases of urticaria involve some kind of allergy, though some cases of chronic urticaria are either categorized as idiopathic (basically, the cause is unknown) or they have a correlation with an autoimmune disease (similar to how I described psoriasis above).

One study published in the Journal of Allergy and Clinical Immunology in 1989 suggested that if a mother and her infant avoided all the most common allergens (including wheat) in the infant’s first year of life, these skin conditions may not develop.

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So Do I Have A Gluten Allergy Rash?

The appropriate gluten allergy tests should help you determine whether or not the rash you’ve developed was triggered by gluten. For more detailed information on the different types of tests, including the industry standards, read my article on gluten intolerance testing.

At this point in our understanding, if you test negative for celiac disease, wheat allergy and dermatitis herpetiformis, it is unlikely that your rash is closely related to gluten or wheat. However, this may change as our understanding of non-celiac gluten sensitivity evolves.

While the research and understanding of gluten intolerance appears to be evolving and improving at a rapid pace right now, if you test negative for these three conditions don’t assume you are suffering from some form of gluten allergy or sensitivity and that science just hasn’t caught up with the reality of this complex protein composite and how it impacts our bodies.

While in a few cases this may turn out to be true, I am concerned some people who are searching for an answer may blame their problems on gluten without having any formal medical confirmation that gluten is causing their ailments. The reason this concerns me is that if you conclude that gluten is the problem without a medical professional confirming this, you may actually miss the real cause and thus not properly treat your condition.

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