NASPGHAN Clinical Report on the Diagnosis and Treatment of Gluten‐related Disorders

Abstract

Dietary exclusion of gluten-containing products has become increasingly popular in the general population, and currently ∼30% of people in the United States are limiting gluten ingestion. Although celiac disease (CD), wheat allergy (WA), and nonceliac gluten sensitivity (NCGS) constitute a spectrum of gluten-related disorders that require exclusion of gluten from the diet, together these account for a relatively small percentage of those following a gluten-free diet, and the vast majority has no medical necessity for doing so. Differentiating between CD, WA, and NCGS has important prognostic and therapeutic implications. Because of the protean manifestations of gluten-related disorders, it is not possible to differentiate between them on clinical grounds alone. This clinical report will compare and contrast the manifestations of gluten-related disorders, emphasize the importance of differentiating between these conditions, discuss initial and subsequent tests needed to confirm the diagnosis, and provide recommendations on treatment and follow-up for each condition.

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“…The immune response can be immunoglubulin E (IgE) mediated, non-IgE mediated, or a combination of both. WA is most commonly a food allergy, but, wheat can become a sensitizer when the exposition occurs through the skin or airways (baker´s asthma) [1]. NCGS is a poorly defined syndorme, characterized by a variable combination of intestinal and extraintestinal symptoms, typically occurring soon after ingestión of gluten-containing food, and disappearing quickly upon their withdrawal, occurring in individuals where, both, CD and WA have been excluded [6].…”

“…It is caracterized by inflammatory enteropathy, with variable degrees of severity, a wide range of gastrointestinal and/or systemic complaints, and the presence of celiac-specific auto-anti-bodies; is the more frequent inflammatory gastrointestinal disease in west countries [1][2][3][4].We describe two adolescents with digestive and systemic symptoms and signs related to gluten ingestion, with abnormal histopathologic findings and abscence of gluten and transaminase auto-antibodies, IgG and IgA, and negative for wheat IgE allergy, they had clinical remission on gluten free diet, and exaceration when they eat gluten, both associated to non-specific IBD, wich improved with prednisone. a.…”

“…It is caracterized by inflammatory enteropathy, with variable degrees of severity, a wide range of gastrointestinal and/or systemic complaints, and the presence of celiac-specific auto-anti-bodies; is the more frequent inflammatory gastrointestinal disease in west countries [1][2][3][4].…”

Two Adolescents with Gluten Sensitivity, Non Celiac, not Wheat Allergy, Associated with Non Specific Inflammatory Bowel Disease

“…It is caracterized by inflammatory enteropathy, with variable degrees of severity, a wide range of gastrointestinal and/or systemic complaints, and the presence of celiac-specific auto-anti-bodies; is the more frequent inflammatory gastrointestinal disease in west countries [1][2][3][4].We describe two adolescents with digestive and systemic symptoms and signs related to gluten ingestion, with abnormal histopathologic findings and abscence of gluten and transaminase auto-antibodies, IgG and IgA, and negative for wheat IgE allergy, they had clinical remission on gluten free diet, and exaceration when they eat gluten, both associated to non-specific IBD, wich improved with prednisone. a.…”

“…It is caracterized by inflammatory enteropathy, with variable degrees of severity, a wide range of gastrointestinal and/or systemic complaints, and the presence of celiac-specific auto-anti-bodies; is the more frequent inflammatory gastrointestinal disease in west countries [1][2][3][4].…”