Last week a Missouri state legislator made news when she proposed a new law requiring the declaration of wheat/gluten on labels for shampoo, conditioner, and other so-called hygiene products. The proposal met with praise from some in the gluten-free community, who claim to react strongly to gluten in shampoo and other products. Meanwhile, others in the gluten-free community responded with the equivalent of a furrowed brow, wondering, “Wait a second. I thought you could only react to gluten by ingesting it, so that it reached your small intestine.”
So who’s right?
The skin is a surprisingly complex and tricky organ. I don’t pretend that this blog post will lay it all out neatly for you. There are a lot of avenues to explore, including the distinction between skin manifestations of ingested gluten versus actual skin reactions to surface contact with gluten. But by taking a peek into the peer-reviewed scientific literature, you can open a valuable window into answering the question: Can you react to gluten just through surface contact on your skin?
Spoiler alert: the short answer is yes (for some of you).
But first, we need to get a wee bit of background info and definitions out of the way, so that the discussion of the various studies makes sense.
Antibody responses
Your body has at least five major antibody responses. Two are important here:
- IGG/IGA – these two are associated with celiac disease, and potentially with non-celiac gluten sensitivity
- IGE – a true allergy, known as Type I, which has the potential for anaphylactic response
Skin conditions
- Atopic dermatitis – can involve scaly, itchy rashes; blisters; dry skin
- Urticaria – hives, itchy red welts
- Contact dermatitis – a cell-mediated Type IV response to surface exposure to an irritant (such as poison ivy)
Skin tests for gluten
- Oral challenge – ingested gluten that may cause a skin response
- Skin prick test, intradermal injections – introduce gluten into the layers of the skin to monitor for response
- Patch test – surface application of gluten to monitor for contact response over period of time
Skin reactions to gluten among bakers and other food preparers
Bakers and other food preparers who come into regular contact with wheat flour have been known to develop protein contact dermatitis, as evidenced—for example—by one study from 1993 and another from 2006, in which one third of study subjects developed atopic contact dermatitis.
Skin reactions among celiac disease patients
Early studies from 1976, 1977, and 1980 all found that intradermal (within the skin) injections of gluten caused skin reactions, including among as many as one third of celiac patients in one study. However, I failed to find studies that more explicitly associated surface contact with wheat/gluten with skin reactions among celiac disease patients.
Dermatitis Herpetiformis
This extensively studied condition is sometimes called the skin manifestation of celiac disease. Researchers from a 2006 study failed to produce skin reactions to intradermal injections of gluten fractions. This suggests that DH’s skin rashes are associated with ingested gluten, though many other variables may come into play, and the study group was small.
Ingested gluten manifesting in the skin
But to the point of ingested gluten manifesting as skin reactions, a number of studies, including one from 2000, found that ingested gluten initiated an IGE antibody allergic response that manifested as atopic dermatitis. In such cases, a gluten-free diet reciprocally resolved the dermatitis. Thus what may appear to be a surface skin reaction to gluten is actually caused (and resolved) by the presence (or absence) of ingested gluten in the diet.
Skin reactions in wheat allergy
Compared to the IGG/IGA response of conditions such as celiac disease, the IGE pathway of wheat allergy offers additional insight. In a 1999 study of children with confirmed wheat allergy, 86% had a positive patch test. In other words, their skin reacted to surface contact with gluten. Two years later, a 2001 study, again of children with confirmed wheat allergy and atopic dermatitis, found that an atopy patch test (surface skin exposure to wheat) had a 94% positive predictive value. More recently, a 2008 study again confirmed the surface contact skin reaction to gluten among those with wheat-allergic atopic dermatitis.
Finally, in a 2004 study that bridged the worlds of celiac disease and wheat allergy, researchers found that a small percentage of patients with celiac disease also had wheat allergy, including a higher rate of IGE-associated atopic dermatitis. For such patients, they may have skin reactions to surface contact with gluten, but it’s not their celiac disease at work, it’s the wheat allergy.
Interesting.Thanks for that info. I have DH, one of the two markers that diagnosed my celiac disease. (I also had the blood test.) I am extremely sensitive to ingested gluten but I don’t believe I have a problem with touching products with gluten in them. I have a separate toaster, food prep area, and cutting board to cut down on cross contamination in my home, but I’ll still fix my husband a sandwich on regular bread. I make sure to wash my hands afterward, but only because I don’t want any trace amounts to end up on my food.
Your post was so wonderful that I had to share a link to it on my blog.
I cannot touch a baked good, I cannot use gluten in hair products. My Celiac is both internal and external. I will get a rash that will last months after contact. I also get rashes when I ingest gluten.
Hello! Please tell me what kind of rash you get~ I believe I have DH, and I know I have celiac. It seems as though my hand is taking the brunt of the disease, itchy painful rash, knuckles swelling, burning red dryness, it looks scalded, & lastly the aweful garlic smell. Do you have any insight?
Very interesting post. I’ve studied about this issue as well, and while I agree with most of the Celiac experts on most issues, I have to say that my own experience is contrary to what they say. I have Celiac but do not suffer any skin reaction when I ingest/touch/breath gluten. However, I have had my typical “glutening” reaction (migraine, brain fog, stomach cramps, fatigue, joint pain, etc.) after only touching gluten (the culprit was rolling out playdough in my son’s class). I knew it had wheat in it, so I was very careful to not touch my face, and washed with soap immediately after helping the kids. Then headed to teacher’s bathroom and washed again with hot water and more soap. Had my gluten reaction at exactly the same amount of time afterwards as has always happened in an accidental ingestion. So for me, I do have an internal reaction to gluten contact (also happened another time when just touching some wheat bread to make a sandwich for someone), but no skin reaction.
I try not to spread any rumors regarding this, but can point 100% to this happening to me. So I just tell people to be careful and to watch and see. Contact with gluten might bother them, it might not.
Any time i roll flour dumplings the palm of my hands itches intensely and i also recall using a face powder some years ago that caused my entire face to break out just after one application.
Thanks for the info. I am working for a large natural food store and was considering working in the kitchens primarily with gluten products, but there will be flour in the air from pizza, calzones, etc,and I am starting to be concerned about the constant interaction with it, breathing it, and possible reactions. We wear gloves, so I think breathing it or excess flour landing on my arms would be the largest culprit. I am pretty sensitive, and think that my skin and hair products are causing reactions. I appreciate this information.
This really helped my knowledge of gluten and Celiac. I have Celiac and only found out a couple of weeks ago. I’m trying to learn all I can. I just crumbled some crackers for a squash casserole and after touching them my palms and fingers were itching terribly. I washed my hands 3 times and it still took a little while to stop. I googled the question and found all of this info. Thanks people for the insite!!
Before I was diagnosed with celiac disease, I used a shampoo from Vidal S. that gave me dandruff. I stopped using it and dandruff went away. I was diagnosed with celiac and it occurred to me to look at the
label and the shampoo contained wheat. So I asked myself if reaction through skin contact like you say it is a reality. I think more studies need to be done, because there is something here that is missing. Thank you for the article, it is a good read.
I’m sitting with a face full of hives at the moment from being in a wheaty house. I touched the supposedly clean dining room table, the mayonnaise bottle…no known gluten/wheat ingestion, and yet I’m reacting. I have a confirmed wheat allergy. This crazy sensitivity feels like a disability today. Thanks for the info.
I have had celiac for 4 years. I recently had a DH outbreak, and I believe it was from my job. I am a Chef, and for some reason going into my fourth year of having celiac disease. I had external contact with some seasoned flour, and that’s when I broke out with a rash over a good part of my body.. I got a steroid shot from my dermatologist, and it went away in about a day. My question is ! Does touching flour, and having DH rash cause damage to your small intestine??? Would like to know!
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Realise an old post but whatva relief to hear of others reacting to wheat ingestion through skin only contact. I have on occassions been having terrible foot and leg cramps which is a sign for me of having had wheat contact. And everytime this happens i can always trace it back to some new cosmetic shampoo conditioner, face cream. I knowv100% it is through skin absorption but just keep banging into a brick wall of” It cannot be as too large particles etc etc” Even accredited sites state this. But I know personally I do absorb not sure how but as someone posted there is “something missing still in research” as I am reacting this way. Every single time without fail I react . So thank you everyone on here who has comented what a relief to hear. Sorry of your suffering but thanks for sharing
Cosmetics have a bad history of maki g people ill. However, anecdotal and me too stories on wheat or gluten in shampoos have surfaced i the Herbal essences from Procter and Gamble. Their customer services, gave platitude replies to my scientific enquiry on their ‘gluten free ‘ adverts. Their advertising agents were missi g tricks because they do t say if their shampoo is lactose or peanut free!!! We are in the realms of the we know what we know, but we dont know what we dont know and so even the sainted P and G are not being fully supportive of all you sensitive people.
These statements give real science a bad name as people jump on half a bandwaggon and feel safe when they are not.
I made wheat flatbread for my kids and used gluten free dough made previously for me separately. I had stomach and pain reaction as if I had eaten it. There could have been trace crossover but I have had this reaction before when making gluten dough for others. I came looking to see if skin contact was known for thos. Looks like I am not alone. Thanks for the info
I have severe gluten sensitivity.. Last year I had pityriasis roses for about 3 months.. I work in a restaurant as a waitress so I’m constantly in pain because gluten is everywhere.. My joints and all over hurts, eyes watery, weakness all over etc.. Sometimes I feel like this is a death sentence.
As a Celiac sufferer I avoid gluten ingestion at all costs. Recently I have been taking particular notice of symptoms and reactions that might explain cross contamination issues.
I made sandwiches for my husband with rye bread and within 5 minutes of handling the bread, my hands, scalp, and forearms started itching. Before long I developed a nice set of hive wheels. So It appears that there may be some connection between gluten and skin contact causing gluten sensitivity issues.
This is such a great article! Thank you for bringing a lot of the studies into one place so I can see the history. I have had unexplained itching for years from certain shampoos and over the years I developed a preference for silk protein shampoo. Then I found out about Celiac and AHA! so that’s why.