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Gluten sensitivities and the allergist: Threshing the grain from the husks
Author(s) -
Burkhardt J. G.,
ChapaRodriguez A.,
Bahna S. L.
Publication year - 2018
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.13354
Subject(s) - medicine , gluten , allergy , food allergy , disease , immunology , anaphylaxis , wheat allergy , gliadin , coeliac disease , environmental health , pediatrics , pathology
Abstract “Gluten sensitivity” has become commonplace among the public. Wheat allergy ( WA ) and celiac disease ( CD ) are well‐defined entities, but are becoming a fraction of individuals following a gluten‐free diet (GFD). Wheat allergy has a prevalence of <0.5%. Wheat, specifically its omega‐5 gliadin fraction, is the most common allergen implicated in food‐dependent, exercise‐induced anaphylaxis. CD is a non‐IgE hypersensitivity to certain cereal proteins: gluten in wheat, secalin in rye, hordein in barley, and to a lesser extent avenin in oat. It is a rare disease, with an estimated prevalence that varied widely geographically, being higher in Northern Europe and the African Saharawi region than in South‐East Asia. In addition to suggestive symptoms, serologic testing has high diagnostic reliability and biopsy is a confirmatory procedure. Patients with CD have extra‐intestinal autoimmune comorbid conditions more frequently than expected. A third entity is nonceliac gluten sensitivity, which has been created because of the increasing number of subjects who claim a better quality of life or improvement of their variety of symptoms on switching to a GFD. The phenomenon is being fueled by the media and exploited by the industry. The lack of a specific objective test has been raising substantial controversy about this entity. Allergists and gastroenterologists need to pay attention to the multitudes of individuals who elect to follow a GFD. Many such subjects might have WA , CD , or another illness. Providing them with appropriate evaluation and specific management would be of great advantages, medically and economically.