Enfermedad celíaca, sensibilidad no celíaca al gluten y alergia al trigo: comparación de patologías diferentes gatilladas por un mismo alimento

Abstract

Gluten and other related proteins of the wheat, rye and barley, have antigenic properties that may trigger adverse reactions in susceptible individuals. Celiac disease was the first pathology with clear causal association related to the intake of these proteins. Recently, wheat allergy and non celiac gluten sensitivity have been described. Although, clinical presentation and its relation with protein ingestion may be similar and elicit confusion, their pathogenic mechanism, diagnosis and treatment are quite different. Since the prevalence of these diseases is relatively high as a whole, it is essential that these become familiar to primary care doctors and general pediatricians, thus they will know how to differentiate and face them. The aim of this review is to compare the main aspects of epidemiology, pathofisiology, diagnosis and treatment of these 3 conditions.

Pathogenesis of Celiac Disease and Other Gluten Related Disorders in Wheat and Strategies for Mitigating Them

“…IgE mediated allergic responses occur immediately after food consumption, are food-specific and reproducible (245) and result from the release of histamine, platelets activator factor, and leukotrienes from mast cells and basophils (246,247). These allergic reactions can affect skin, respiratory or gastrointestinal tract and are characterized by TH2 lymphocytic inflammation which leads to the production of IL-4, IL-5, and IL-13; and causes B cells to produce IgE antibodies specific to certain foods (215,248,249). Genetic characteristics of individuals as well as environmental factors play an important role in the onset of such immune response (250,251).…”

“…Though a number of diseases and conditions arise from wheat intake in certain individuals who cannot tolerate it but wheat consumption is safe for a wide percentage of individuals who can tolerate it. Globally 1.4% of individuals are reported for CD (53), 0.63-6.0% for NCGS (278), and 0.2-1.0% for wheat allergy (245,249). Hence, at maximum, only 8.4% population is susceptible to wheat-related disorders and the remaining 91.6% population remains safe for the intake of wheat and should not remove it from diet based on false media coverage ( Figure 5).…”

Coeliac disease in children

“…In both these conditions, unlike coeliac disease, wheat can potentially be reintroduced to the diet without long term sequelae 2122…”

An updated overview of spectrum of gluten-related disorders: clinical and diagnostic aspects

“…WA is more common in pediatric practice than adult medicine (the mean age of onset for WA is 5.5 years (3–16 years)) and the global prevalence of WA is reported at 0.5–1% [ 105 – 108 ]. Wheat allergy as a subgroup of food hypersensitivity is categorized into two groups; IgE-Mediated and non-IgE-Mediated WA [ 108 – 110 ].…”

“…Cross-linking of IgE with gluten peptides triggers the release of chemical mediators such as histamine from basophils and mast cells, leading to the clinical manifestations of allergic responses, including WA [ 109 , 111 ]. The most common manifestations of WA due to these mechanisms include gastrointestinal (abdominal pain, nausea, vomiting, diarrhea, bloating), dermal (itching, eczema, pruritus, dizziness, atopic dermatitis, swelling, redness), respiratory (rhinitis, asthma, sneezing, chronic cough), circulatory (flushing, angioedema), cerebral (disturbed or foggy thinking, headache, dizziness, migraines) symptoms [ 108 , 110 ]. These manifestations can be immediate (minutes to an hour after ingestion) or delayed (a few hours after oral ingestion of wheat) [ 112 ].…”