“…In fact, one identical twin may have celiac disease while the other suffers from dermatitis herpetiformis [ 11 ]. Other gluten-driven extra-intestinal manifestations in celiac disease include osteopenia, osteoporosis, fractures [ 12 , 13 , 14 ], permanent tooth enamel defects [ 6 , 15 ], arthritis, and arthralgia [ 16 , 17 , 18 ] as well as further central and peripheral nervous system [ 19 , 20 , 21 , 22 ], liver [ 23 , 24 , 25 ], and reproductive system involvements [ 26 , 27 ]. Even autoimmune diseases may be gluten driven [ 28 , 29 ], and there is a risk for malignant complications, especially non-Hodgkin lymphoma, in untreated celiac disease [ 30 , 31 ].…”