Friday, January 22, 2021

Three types of gluten intolerance

Gluten intolerance is an umbrella term integrating three major types of gluten-related disorders: autoimmune celiac disease (CD), allergy to wheat and non-celiac gluten sensitivity (NCGS).

Gluten is a mixture of seed storage proteins found in grains such as wheat, rye, barley and oat. Gluten proteins appear to be prolamins due to the significant amount of glutamine and proline amino acid residues present in their primary structure.

Celiac disease is an autoimmune enteropathy caused by genetic and environmental factors, with an estimated worldwide prevalence of about 1%. Celiac disease has been known for more than 2,000 years and it was already in the middle of the 20th century that its relationship with gluten intake was established.

The disease triggered by the ingestion of gluten and related prolamins in genetically susceptible individuals and characterized by a variable combination of clinical manifestations, specific antibodies, HLA DQ2 and DQ8 haplotypes and enteropathy.

Allergy to wheat is represented by a food IgE-mediated allergy, which is most frequently based on the sensitization to wheat protein allergens. It has been shown that wheat ω5-gliadin is the main allergen of gluten, inducing wheat-dependent exercise-induced anaphylaxis.

Allergy to wheat is characterized by the presence of digestive, respiratory and/or cutaneous symptoms, triggered by exposure to wheat through mucous (digestive or respiratory) or skin. 
One more gluten-related disorder has been proposed— Non-celiac gluten sensitivity NCGS—and its pathogenesis is still not clear. Gluten ataxia (GA) is one of a number of different neurological manifestations attributed to celiac disease, but there is also suggestion that it is related to NCGS.

Non-celiac gluten sensitivity (NCGS), also referred to as non-celiac wheat sensitivity (NCWS), is a clinical syndrome characterized by both intestinal and extra-intestinal symptoms responsive to the withdrawal of gluten containing food from the diet.

Several epidemiologic studies have suggested that Non-celiac gluten sensitivity NCGS may affect a variable range (from 0.5% to 13%) of the Western population. Currently, NCGS is a syndrome characterized by intestinal and extraintestinal symptoms related to the ingestion of gluten-containing food, in subjects in whom either celiac disease or wheat allergy previously has been ruled out.
Three types of gluten intolerance

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