Weizenunverträglichkeiten – Hype oder Herausforderung?

Zusammenfassung

Die Weizenallergie, die Zöliakie und die Nicht-Zöliakie-Nicht-Allergie-Weizensensitivität (Non-celiac-wheat sensitivity; NCWS) werden als Weizenunverträglichkeiten zusammengefasst. Trotz unterschiedlicher Pathomechanismen äußern sich alle 3 Entitäten durch zum Teil überlappende Symptome. Die Weizenallergie ist weltweit die häufigste Nahrungsmittelallergie bei Erwachsenen und kann entweder IgE- oder nicht-IgE-vermittelt auftreten. Sie ist gegen verschiedene Weizenproteine gerichtet, weshalb die Betroffenen eine lebenslange weizenfreie Therapie einhalten müssen. Auch glutenfreie Lebensmittel sollten aufgrund eventuell vorhandener, glutenfreier Weizenstärke gemieden werden.

Zöliakie, eine glutensensitive Enteropathie, tritt fast ausschließlich bei genetisch disponierten Individuen auf. An der Pathogenese sind sowohl das angeborene als auch das adaptive Immunsystem beteiligt. Durch die Entstehung von Antikörpern gegen ein körpereigenes Enzym, die Gewebstransglutaminase, besitzt diese Krankheit zusätzlich eine autoimmune Komponente. Unter Einhaltung einer strikt glutenfreien Diät (< 10 mg Gluten pro Tag) verbessern sich bei den meisten Patienten die Symptome rasch.

Während die Mechanismen der Weizenallergie und der Zöliakie bereits eingehend untersucht wurden, besteht noch Unklarheit bezüglich der NCWS. Diese relativ neue Krankheitsentität kann bisher nur mittels Ausschlussdiagnose von Weizenallergie und Zöliakie festgestellt werden. Obwohl die genauen Auslöser dieser Krankheit noch nicht identifiziert sind, es werden FODMAPS, Gluten und α-Amylase-Trypsin-Inhibitoren diskutiert, stellt eine glutenfreie Ernährung die einzig mögliche Therapie dar.

Als Ursache für die Zunahme von Getreideunverträglichkeiten werden Veränderungen bezüglich der Hygienemaßnahmen, der Getreidegenetik, der Herstellungsverfahren für Brot und Backwaren, der Ernährungsweise, und schließlich eine intensiver verwendete Diagnostik diskutiert.

Abstract

Wheat allergy, celiac disease and non-celiac-wheat-sensitivity (NCWS) are summarized as wheat sensitivities. Although the pathomechanisms are different, the three entities show overlapping symptoms. Wheat allergy is the most common food intolerance in adults worldwide. It can be either IgE mediated or non-IgE mediated. This allergy is directed against various wheat proteins and the patients need to adhere to a wheat-free diet their whole lifetime. Even gluten-free foods should be avoided, as they might eventually contain gluten-free wheat starch.

Celiac disease, a gluten-sensitive enteropathy, almost entirely appears in genetically predisposed individuals. Both the innate and the adaptive immune system are involved in the pathogenesis of celiac disease. The formation of antibodies against the tissue transglutaminase, an endogenous enzyme, represents an additional autoimmune component. If patients adhere to a strict gluten-free diet (< 10 mg gluten per day), their symptoms quickly improve in most cases.

While the mechanisms of wheat allergy and celiac disease are already studied in detail, there is still some uncertainty regarding NCWS. This relatively new entity is still a diagnosis of exclusion. Although the exact trigger mechanisms are not identified yet – FODMAPS, gluten and -amylase-trypsin inhibitors are discussed to be triggers – a gluten-free diet is the only possible therapy.

Changes regarding hygiene measures, the genetics of wheat, manufacturing processes of bread, specific diets and more intensely used diagnostics are discussed to be reasons for the rise of wheat sensitivites.

Schlüsselwörter

Weizenallergie - Zöliakie - Nicht-Zöliakie-Nicht-Allergie-Weizensensitivität - Nahrungsmittelunverträglichkeiten - Nahrungsmittelallergien

Keywords

wheat allergy - celiac disease - non-celiac-wheat sensitivity - food intolerances - food allergies

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