FCAAIA Notes: Gluten is one of the big “black boxes” of this century.  Celiac disease is more common than appreciated a generation ago.  Unlike when I went to medical school, we now recognize it can present with mild symptoms. The gold standard for diagnosis of celiac disease is biopsy, but it can often be presumed in the context of certain blood tests. Those tests need to be done without gluten elimination.  Some people won’t re-introduce gluten for testing.  In those cases, they can be tested for the genes present in over 90% of celiac patients.  However, only about 50% of people who have those genes have celiac disease!

There are many people whose symptoms mimic celiac but whose testing and genotype for celiac are negative.  Those patients have “non-celiac gluten enteropathy” (formally called non-celiac sprue).  It is important to know if one’s gluten intolerance is celiac or non-celiac, as the former is known to have long term risk for complications if dietary gluten is not eliminated. It is not known if patients with non-celiac gluten enteropathy have any long term risks.

Many patients (and alternative practitioners) attribute virtually any symptoms in any body system to “gluten”.  Often, tests that have no scientific validity are used to make the diagnosis. Gluten elimination may or may not lead to relief, and if it does it is often a “placebo effect.”  For those patients, I feel that it doesn’t matter; no one has to eat gluten, but it is important to know who has to avoid it.

(Source: Dec. 13, 2016. For Medscape articles: User name: FCAAIA, Password: Allergies)


Objective Wheat gluten and related proteins can trigger an autoimmune enteropathy, known as coeliac disease, in people with genetic susceptibility. However, some individuals experience a range of symptoms in response to wheat ingestion, without the characteristic serological or histological evidence of coeliac disease. The aetiology and mechanism of these symptoms are unknown, and no biomarkers have been identified. We aimed to determine if sensitivity to wheat in the absence of coeliac disease is associated with systemic immune activation that may be linked to an enteropathy.

Design Study participants included individuals who reported symptoms in response to wheat intake and in whom coeliac disease and wheat allergy were ruled out, patients with coeliac disease and healthy controls. Sera were analysed for markers of intestinal cell damage and systemic immune response to microbial components.

Results Individuals with wheat sensitivity had significantly increased serum levels of soluble CD14 and lipopolysaccharide (LPS)-binding protein, as well as antibody reactivity to bacterial LPS and flagellin. Circulating levels of fatty acid-binding protein 2 (FABP2), a marker of intestinal epithelial cell damage, were significantly elevated in the affected individuals and correlated with the immune responses to microbial products. There was a significant change towards normalisation of the levels of FABP2 and immune activation markers in a subgroup of individuals with wheat sensitivity who observed a diet excluding wheat and related cereals.

Conclusions These findings reveal a state of systemic immune activation in conjunction with a compromised intestinal epithelium affecting a subset of individuals who experience sensitivity to wheat in the absence of coeliac disease.

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