Zöliakie, Getreideallergie, Weizensensitivität: Glutenfreie Ernährungstherapie

Die 3 wichtigsten Krankheitsbilder einer Getreideunverträglichkeit stellen die Zöliakie, Getreideallergie und Nicht-Zöliakie-Nicht-Weizenallergie-Weizensensitivität (NZNWWS) dar. Dieser Beitrag grenzt diese voneinander ab, zeigt Beschwerden auf und stellt jeweils die differenzierte Diagnostik sowie Ernährungstherapie vor.

Abstract

Glutensensitivity represents celiac disease, wheat allergy and non-celiac glutensensitivity (NCGS). Gastrointestinal complaints, e. g. abdominal pain, diarrhea, obstipation, flatulence, nausea and vomiting, as well as extra intestinal problems, e. g. headache, muscle and joint pain, fatigue or skin disorders, are common symptoms in these diseases. A correct diagnosis is mandatory for an appropriate individually adapted therapy.

Celiac disease is triggered by gluten from wheat, rye and barley, as well as related cereals e. g. spelt, Einkorn or Emmer. In genetically predisposed individuals dietary gluten ingestion causes an activation of the immune system and the destruction of the intestinal mucosa that results in a generalized nutrient malabsorption and -digestion. For diagnosis the celiac specific IgA anti-transglutaminase 2/IgA anti-endomysium antibodies are determined and mucosal damage is evaluated according Marsh-Oberhuber criteria. In case of reduced serum IgA the detection of IgG antibodies against transglutaminase 2 is recommended. A lifelong strict glutenfree diet is the only available therapy.

Cereal allergy represents different forms. The respiratory wheat allergy is mainly caused by inhalation of cereal flour, contact urticaria by contact with wheat, and gastrointestinal complaints after oral food intake. Both, IgE triggered immediate hypersensitivity reactions and T cell induced late-phase or delayed-type hypersensitivity reactions may cause clinical symptoms. Several cereal components were identified as triggers for allergy and are able to induce cross reactions with other cereal proteins or inhaled substances. The diagnosis for immediate hypersensitivity response is based on a skin-prick-test and determination of total IgE and specific IgE against cereal proteins. Since wheat is the most frequently cultivated and processed cereal, wheat allergy possesses high therapeutic relevance. Patients with wheat allergy must avoid wheat products. However, rye or barley is well tolerated in most patients.

Patients with NCGS complain about intestinal and extra intestinal symptoms soon after consumption of wheat or other gluten containing products. Besides of gluten other wheat components, like amylase-trypsin-inhibitor or FODMAPs, are discussed for disease trigger. The diagnosis of NCGS is done by exclusion of other diseases and improvement of symptoms under glutenfree diet. The therapy is based on a glutenfree diet that can be less restrictive after some weeks.

Kernaussagen

• Die 3 wichtigsten Krankheitsbilder einer Getreideunverträglichkeit stellen die Zöliakie, Weizenallergie und NZNWWS dar.

• Alle 3 Krankheitsbilder können mit gastrointestinalen Symptomen einhergehen.

• Die Diagnostik der Zöliakie besteht im Nachweis der Serum-IgA-Antikörper gegen Transglutaminase 2 oder Endomysium und dem histologischen Nachweis einer Schädigung der Dünndarmmukosa. Die Diagnostik muss unbedingt unter glutenhaltiger Kost durchgeführt werden.

• Die Therapie bei Zöliakie besteht in einer lebenslangen, strikten glutenfreien Diät. Bereits kleinste Mengen Gluten können eine Schädigung der Mukosa zur Folge haben.

• Bei der Weizenallergie werden je nach Allergenexposition und immunologischer Reaktion verschiedene Formen unterschieden.

• Die Diagnostik einer Weizenallergie besteht aus einer ausführlichen Anamnese in Kombination mit einem Skin-Prick-Test und dem Nachweis von Gesamt- und spezifischem IgE gegen Weizenproteine.

• Weizenallergiker sollten eine weizenfreie Diät einhalten. Roggen und Gerste werden meist toleriert.

• Bei einer NZNWWS klagen die Patienten vorwiegend nach Verzehr von weizenhaltiger Kost über gastrointestinale und extraintestinale Symptome. Eine rasche Besserung erfahren die Patienten bei Einhalten einer glutenfreien Diät. Neben Gluten werden jedoch ebenfalls andere Bestandteile des Weizens als auslösende Agenzien diskutiert.

• Bisher liegen für die NZNWWS keine diagnostischen Parameter vor, sodass die Diagnose auf einer Ausschlussdiagnostik beruht.

• Die Therapie der NZNWWS beruht auf der Einhaltung einer glutenfreien Diät. Nach anfänglich strikter Diät kann hier meist wieder eine geringe Menge an Gluten aufgenommen werden. Ein persönlicher Schwellenwert muss ermittelt werden.

Schlüsselwörter

Weizenunverträglichkeit - Zöliakie - Weizenallergie - Weizensensitivität - Gluten

Keywords

gluten sensitivity - wheat sensitivity - celiac disease - wheat allergy - gluten

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