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Gluten Sensitivity and Eczema
Gluten is the composite protein found in certain grains. Not everyone can fully digest this protein and for those who cannot, the partially digested gluten can damage the intestinal mucosa. Therefore, gluten sensitivity can cause leaky gut syndrome as well as widespread inflammation in the body. But how does the damage done in the gut by gluten affect the skin and what is the link between celiac disease and eczema? Read on to find out the answers to these questions and why gluten-free diet may the miracle cure for your eczema.
by Brad Chase
Gluten is a protein commonly found in grains like wheat, rye, oats and barley. It gives grain products a chewy texture as well as elasticity. Gluten is also added to processed foods to serve as a protein source.
Gluten is a composite protein made up of 2 compounds: gliadin and glutenin. These compounds are held together in the starch matrix of the grain endosperms.
In most developed countries, health regulatory bodies require manufacturers to state the gluten content of processed foods on the products’ labels. This is because not everyone can tolerate gluten.
Gluten intolerance is a feature of a number of diseases including those with clear gastrointestinal involvement such as celiac disease and others with no obvious connection such as eczema. Sensitivity to this grain protein can cause bloating, diarrhea, constipation, muscle pain, abdominal pain as well as pain in the bone and joint.
Gluten sensitivity may also result in anaphylaxis reaction especially when triggered by exercise or regular use of NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin and ibuprofen.
When gluten sensitivity develops in early childhood, it almost always causes lifelong chronic diseases that can only be controlled with gluten-free diet.
Although the signs of gluten sensitivity may suggest that it is a presentation of autoimmune disorder, studies actually show that it involves innate immune response to gluten.
Gluten sensitivity is also more common among the elderly than in the general population. This is most likely due to the failing tolerance of the immune system to gluten.
People with gluten sensitivity usually produce antibodies against gliadin and other grain proteins.
Specifically, studies show that more than half of those diagnosed with this food sensitivity produce the immunoglobulins, IgA and IgG, in the form of anti-gliadin antibodies.
Therefore, the body regards gluten as a foreign substance. In fact, scientists believe that gliadin is grains’ evolutionary response to animals that consume them. And this storage protein does cause intestinal diseases in the animals that feed on certain grains.
Studies show that gliadin increases the permeability of intestinal cells in humans. This means that gliadin can make the gut leaky.
In addition, gliadin can also trigger the release of a destructive substance in the gut when it binds to a special class of receptors there. This substance released damages the tight junctions between the cells of the small intestine.
Since the tight junctions are responsible for sealing the absorptive mucosal surfaces of the small intestine, destroying them will also cause leaky gut syndrome.
In leaky gut syndrome, the increased permeability of the gut allows harmful bacteria, toxins, undigested food particles and other foreign substances to reach the bloodstream. These toxic substances are then transported to different parts of the body. Therefore, they can cause seemingly unrelated diseases in organs far from the gut.
Leaky gut syndrome also triggers inflammatory response from the immune system as the body tries to contain the damage done to the gut and other organs.
Therefore, gluten sensitivity can cause eczema through leaky gut syndrome and this can promote anaphylactic reactions and inflammation in the deep layers of the skin.
The progressive damage done to the skin will allow pathogenic microbes to colonize it. The results of this microbial invasion of the skin are itching, scaly dry skin and eczematous lesions.
Studies show that there is a genetic link between celiac disease and eczema and that this link involves gluten sensitivity.
When researchers compared the prevalence of eczema among people with celiac disease to the general population, they found that eczema is 3 times more common among people with celiac disease than the rest of the population.
In addition, they found that celiac disease occurs 2 times more frequently among otherwise healthy relatives of celiac disease patients.
Although gluten sensitivity is often closely associated with celiac disease, it can also be present without clear diagnosis of celiac disease.
Therefore, gluten sensitivity should still be suspected in eczema even when the sufferer tests negative to celiac disease or gluten allergy. This is because most people with eczema have gluten sensitivity although to different degrees.
For example, while some eczema patients get total relief from going gluten-free, some only experience fewer symptoms with gluten-free diets and others get better by simply reducing their gluten intake.
While eczema may not fully develop from regular consumption of gluten-containing grains and food products, eczema-like conditions may still appear from the leaky gut syndrome associated with the skin disease as well as the improper immune reaction to gliadin.
For example, gluten consumption is known to cause dermatitis herpetiformis which appears as an eczema-like rash.
Like eczema, this rash results from the negative effect of gluten antibodies in the skin. It is common among people with celiac disease and it responds to gluten-free diet too.
A 2006 study published in the European Journal of Dermatology summarized the state of research on gluten sensitivity and skin diseases.
The researchers identified that gluten intolerance with or without celiac disease can be the root cause of a number of skin diseases ranging from itching and psoriasis to vitiligo and eczema. They also recommended that dermatologists should be aware of the influence of gut damage and diet to skin health.
For the diagnoses of skin diseases caused by gluten intolerance, the authors of the paper recommended that doctors use a number of serological tests including screening for anti-gliadin antibodies in the sera of patients.
Where these tests are inconclusive or inadequate, physical examination of the intestine is recommended to fully diagnose celiac disease and gluten intolerance.
Finally, the researchers recommended the adoption of gluten-free diet to help treat these skin diseases.
A 2004 study published in the journal, Allergy, also provided similar recommendations. Here the researchers studied the role of food in the diagnosis of gluten sensitivity in children experiencing atopic eczema.
The researchers recognized that the usual battery of medical investigations (history of the patient, skin prick test, patch test for allergens and serum immunoglobulin E levels) may not provide a clear diagnostic picture for doctors.
Therefore, they recommended oral food challenge as a thorough but more challenging diagnostic test.
This involves giving the patient a food known to cause no allergies (such as gluten-free diet), the suspected food (food with possible gluten content) or placebo and watching the patient’s reaction to each of these.
In the case of atopic eczema, the researchers recommended that 48 hours be allowed for each test food.
There are a number of benefits for using this technique. First, it reveals the specific gluten-containing food that triggers eczema for the individual patient. Secondly, it saves the patient the time and cost of trying out different diets that may cause further damage to the gut.
A 1996 study published in the French journal, Archivies de Pediatrie, described 8 cases of eczema (specifically, dermatitis herpetiformis) in patients who were diagnosed with celiac disease in childhood.
Each of these patients put their celiac disease in remission by adopting gluten-free diets. Subsequently, the levels of anti-gliadin antibodies fell with the adoption of the diet.
Upon resuming the consumption of gluten-containing foods, 3 of these patients promptly developed the eczema-like rash while it took some years after the reintroduction of gluten for eczema to reappear in another 3 patients.
The researchers showed that the onset of eczema after reintroducing gluten depended on the speed of accumulation of immunoglobulin A (IgA) in the skin.
Following early sensitization in childhood, subsequent introduction of gluten can increase the production of IgA. When this immunoglobulin reacts with the skin, it causes the different symptoms of eczema.
This study shows that eczema patients may need to adopt lifelong gluten-free diets to keep the disease in remission.
A 2006 paper published in the Canadian Journal of Gastroenterology described the case of a 24-year old woman who presented with gastrointestinal pain, itching and skin ulcers.
After performing a small-bowel biopsy, her doctors diagnosed her with celiac disease. When she was placed on gluten-free diet, all her symptoms completely resolved.
The authors of the paper concluded that her skin problems were a manifestation of the celiac disease.
Because her skin problems closely resembled the beginning of eczema, it is right to conclude that there is a strong tie between celiac disease and eczema. In fact, the researchers recognized that certain nutritional deficiencies are common in both eczema and celiac disease.
For example, the malabsorption of iron, B vitamins and vitamin D is responsible for the prevalence of deficiencies of these nutrients in eczema. This malabsorption is clearly caused by the leaky gut syndrome brought on by gluten intolerance.
In conclusion, the researchers recommended the adoption of gluten-free diet for treating both celiac disease and eczema. In their view, such diet produced better results than most drug interventions.
A case report published in the Journal of Chiropractic Medicine in 2011 described the treatment of a 28-year woman who had severe eczema coupled with celiac disease.
Prior to treatment, the patient experienced itching, eczema, constipation, heartburn and constipation. She was then placed on oral and topical corticosteroids but her symptoms did not improve.
The author of the paper then gave her 3 weekly sessions of acupuncture for 12 weeks. After the first 12 acupuncture sessions, constipation and itchy skin disappeared from the list of symptoms while heartburn improved.
The patient then stopped taking corticosteroids and adopted a gluten-free diet along with acupuncture.
After the second 12-week acupuncture sessions, the patients’ heartburn, headache and eczema disappeared. The other symptoms were also fully resolved after the last 12-week acupuncture sessions.
The researcher concluded that combining acupuncture with gluten-free diet produced better results than gluten-free diet alone in the treatment of eczema.
This case study demonstrates that the combination of acupuncture and gluten-free diet can provide quick relief for eczema patients even when it is difficult to diagnose the involvement of celiac disease. Just as importantly, this study shows that these non-drug interventions were superior to the steroid treatment commonly recommended for eczema patients.
One of the effects that grain proteins have on the immune system is the stimulation of immunoglobulins. When immunoglobulin E (IgE) is stimulated, it can trigger inflammation in the gut and in the skin. Therefore, IgE involvement is important to the development of eczema.
A 1982 study published in the journal, Clinical and Experimental Allergy, provided a clear picture of the interaction between grain proteins and IgE antibodies.
By measuring the levels of these antibodies produced in the sera of 20 pediatric patients with asthma and/or eczema, the researchers discovered that
Although IgE antibodies are only partly responsible for the skin reactions caused by gluten intolerance, the study still agrees with established observation that
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