Nonceliac Wheat Sensitivity in the Context of Multiple Food Hypersensitivity: New Data From Confocal Endomicroscopy

Carroccio, Antonio; D’Alcamo, Alberto; Mansueto, Pasquale

doi:10.1053/j.gastro.2014.11.047

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…For this reason, ID could mask CD, and the frequent association between CD and ID is a diagnostic challenge for the clinician, the endoscopist and the pathologist. Apart from gluten-related disorders, indeed, a condition of villous atrophy or duodenal lymphocytosis may be linked to other disorders such as alimentary atopy, inflammatory bowel disease, parasitic or viral infections and drugs such as olmesartan [ 22 , 88 , 89 , 90 ], all conditions demanding differential diagnosis, for which a diagnostic algorithm has been proposed [ 12 ]. In Table 4 , we summarize the main causes of duodenal lymphocytosis and villous atrophy.…”

Section: Conclusive Remarksmentioning

confidence: 99%

Seronegative Celiac Disease and Immunoglobulin Deficiency: Where to Look in the Submerged Iceberg?

et al. 2015

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In the present narrative review, we analyzed the relationship between seronegative celiac disease (SNCD) and immunoglobulin deficiencies. For this purpose, we conducted a literature search on the main medical databases. SNCD poses a diagnostic dilemma. Villous blunting, intraepithelial lymphocytes (IELs) count and gluten “challenge” are the most reliable markers. Immunohistochemistry/immunofluorescence tissue transglutaminase (tTG)-targeted mucosal immunoglobulin A (IgA) immune complexes in the intestinal mucosa of SNCD patients may be useful. In our experience, tTG-mRNA was similarly increased in seropositive celiac disease (CD) and suspected SNCD, and strongly correlated with the IELs count. This increase is found even in the IELs’ range of 15–25/100 enterocytes, suggesting that there may be a “grey zone” of gluten-related disorders. An immune deregulation (severely lacking B-cell differentiation) underlies the association of SNCD with immunoglobulin deficiencies. Therefore, CD may be linked to autoimmune disorders and immune deficits (common variable immunodeficiency (CVID)/IgA selective deficiency). CVID is a heterogeneous group of antibodies dysfunction, whose association with CD is demonstrated only by the response to a gluten-free diet (GFD). We hypothesized a familial inheritance between CD and CVID. Selective IgA deficiency, commonly associated with CD, accounts for IgA-tTG seronegativity. Selective IgM deficiency (sIgMD) is rare (<300 cases) and associated to CD in 5% of cases. We diagnosed SNCD in a patient affected by sIgMD using the tTG-mRNA assay. One-year GFD induced IgM restoration. This evidence, supporting a link between SNCD and immunoglobulin deficiencies, suggests that we should take a closer look at this association.

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Section: Conclusive Remarksmentioning

confidence: 99%

Seronegative Celiac Disease and Immunoglobulin Deficiency: Where to Look in the Submerged Iceberg?

et al. 2015

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“…Except for gluten-related disorders, indeed, a condition of villous atrophy or duodenal lymphocytosis may be linked to other disorders like alimentary atopy, inflammatory bowel disease, parasitic or viral infections and medicines like olmesartan. [5,[5][6][7].…”

Section: Discussionmentioning

confidence: 99%

The Association of IgA Deficiency and Celiac Disease: What Hides Under the Iceberg

Saffour¹,

Ouaya²,

Bahri³

et al. 2021

IJI

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Celiac disease is an autoimmune enteropathy, secondary to an allergy to gluten in genetically predisposed subjects, results in clinical polymorphism, with the presence of malabsorption syndrome, is a villous atrophy demonstrated using gastroscopy, which allows to biopsy the duodenal mucosa in order to demonstrate this atrophy at the histological level and also the demonstration of basal lymphocytosis, its associated clinical, endoscopic and histological abnormalities are positive for anti-ACs. IgA-type transglutaminase, the latter may be deficient, the chosen which is frequent in celiac patients compared to the general population, making sometimes the diagnosis is a challenge for the clinician. We report the case of an association between an IgA deficiency and celiac disease in a 20-year-old patient with no personal or family pathological history, revealed by diarrhea with signs of deficiency in connection with malabsorption and the presence of the sign suggestive at endoscopy. digestive system, with an analysis of the relationship between seronegative celiac disease (SNCD) and immunoglobulin A deficiency through a review of the literature on the main medical databases

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TNF-α, IL-17, and IL-22 production in the rectal mucosa of nonceliac wheat sensitivity patients: role of adaptive immunity

Mansueto

Liberto

Fayer

et al. 2020

American Journal of Physiology-Gastrointestinal and Liver Physi

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In recent years, a new gluten- or wheat-related disease has emerged, a condition labelled "non-celiac gluten sensitivity" (NCGS) or "non-celiac wheat sensitivity" (NCWS). NCWS pathogenesis is still uncertain and attributed to very different mechanisms. We aimed to study the different T lymphocyte subsets in the rectal mucosa of NCWS patients, to demonstrate the possible contribution of adaptative immune response. Twelve patients (11 females, 1 male, age range 23-61 years, median 32) with a definitive diagnosis of NCWS were recruited at random for the present study. They underwent rectal endoscopy with multiple mucosal biopsies at the end of a double-blind placebo-controlled (DBPC) wheat challenge when they reported the reappearance of the symptoms. As controls we included 11 "healthy patients", sex- and age-matched with the patients, who underwent colonoscopy evaluation for rectal bleeding due to hemorrhoids. Cells freshly obtained from rectal tissue were stained to detect anti-CD45, anti-CD3, anti-CD4, and anti-CD8. Furthermore, intracellular staining was performed with anti-Tumor Necrosis Factor (TNF)-α, anti-interleukin (IL)-17, and anti-IL-22. Production of TNF-α by CD45+, CD3+, CD4+ and CD8+ cells, as well as of IL-17 by CD4+ cells, was higher in the rectal tissue of NCWS patients than in controls. On the contrary, IL-22 production by CD8+ cells was lower in NCWS patients than in the controls. In NCWS patients diagnosed by DBPC wheat challenge, there is a complex immunological activation, with a significant role for the adaptive response.

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Nonceliac Wheat Sensitivity in the Context of Multiple Food Hypersensitivity: New Data From Confocal Endomicroscopy

Cited by 3 publications

References 8 publications

Seronegative Celiac Disease and Immunoglobulin Deficiency: Where to Look in the Submerged Iceberg?

Seronegative Celiac Disease and Immunoglobulin Deficiency: Where to Look in the Submerged Iceberg?

The Association of IgA Deficiency and Celiac Disease: What Hides Under the Iceberg

TNF-α, IL-17, and IL-22 production in the rectal mucosa of nonceliac wheat sensitivity patients: role of adaptive immunity

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