Mansueto Pasquale, Seidita Aurelio, D'Alcamo Alberto, Carroccio Antonio
a Internal Medicine, University Hospital of Palermo , Palermo , ITALY.
J Am Coll Nutr. 2014;33(1):39-54. doi: 10.1080/07315724.2014.869996.
A significant percentage of the general population report problems caused by wheat and/or gluten ingestion, even though they do not have celiac disease (CD) or wheat allergy (WA), because they test negative both for CD-specific serology and histopathology and for immunoglobulin E (IgE)-mediated assays. Most patients report both gastrointestinal and nongastrointestinal symptoms, and all report improvement of symptoms on a gluten-free diet. This clinical condition has been named non-celiac gluten sensitivity (NCGS).
We attempt to define the current pathogenic, clinical, and diagnostic criteria of this "new" disease, to provide a practical view that might be useful to evaluate, diagnose, and manage NCGS patients.
We reviewed the international literature through PubMed and Medline, using the search terms "wheat (hyper)sensitivity," "wheat allergy," "wheat intolerance," "gluten (hyper)sensitivity," and "gluten intolerance," and we discuss current knowledge about NCGS.
It has been demonstrated that patients suffering from NCGS are a heterogeneous group, composed of several subgroups, each characterized by different pathogenesis, clinical history, and, probably, clinical course. NCGS diagnosis can be reached only by excluding CD and WA. Recent evidence shows that a personal history of food allergy in infancy, coexistent atopy, positive for immunoglobulin G (IgG) antigliadin antibodies and flow cytometric basophil activation test, with wheat and duodenal and/or ileum-colon intraepithelial and lamina propria eosinophil counts, could be useful to identify NCGS patients.
Future research should aim to identify reliable biomarkers for NCGS diagnosis and to better define the different NCGS subgroups. Key teaching points: • Most patients report both gastrointestinal and nongastrointestinal symptoms, and all agree that there is an improvement of symptoms on a gluten-free diet. • NCGS diagnosis can be reached only by excluding celiac disease and wheat allergy. • Patients suffering from NCGS are a heterogeneous group, composed of several subgroups, each characterized by different pathogenesis, clinical history, and, probably, clinical course. • A personal history of food allergy in infancy, coexistent atopy, positive IgG antigliadin antibodies (AGA) and flow cytometric basophil activation test, with wheat and duodenal and/or ileum-colon intraepithelial and lamina propria eosinophil counts, could be useful to identify NCGS patients. • Future research should aim to identify reliable biomarkers for NCGS diagnosis and to better define the different NCGS subgroup.
相当一部分普通人群报告称，即使他们没有乳糜泻（CD）或小麦过敏（WA），但摄入小麦和/或麸质后仍会出现问题，因为他们的CD特异性血清学和组织病理学检测以及免疫球蛋白E（IgE）介导的检测均呈阴性。大多数患者报告有胃肠道和非胃肠道症状，并且所有患者均报告无麸质饮食后症状有所改善。这种临床病症被命名为非乳糜泻性麸质敏感（NCGS）。
我们试图明确这种“新”疾病当前的发病机制、临床特征和诊断标准，以提供一种实用的观点，可能有助于评估、诊断和管理NCGS患者。
我们通过PubMed和Medline检索国际文献，使用的检索词为“小麦（超）敏”“小麦过敏”“小麦不耐受”“麸质（超）敏”和“麸质不耐受”，并讨论了关于NCGS的现有知识。
已证明，患有NCGS的患者是一个异质性群体，由几个亚组组成，每个亚组具有不同的发病机制、临床病史，可能还有临床病程。只有排除CD和WA才能做出NCGS诊断。最近的证据表明，婴儿期食物过敏个人史、并存的特应性、免疫球蛋白G（IgG）抗麦醇溶蛋白抗体阳性以及流式细胞术嗜碱性粒细胞活化试验，以及小麦和十二指肠和/或回肠 - 结肠上皮内和固有层嗜酸性粒细胞计数，可能有助于识别NCGS患者。
未来的研究应旨在确定用于NCGS诊断的可靠生物标志物，并更好地界定不同的NCGS亚组。关键知识点：•大多数患者报告有胃肠道和非胃肠道症状，并且所有人都认为无麸质饮食后症状有所改善。•只有排除乳糜泻和小麦过敏才能做出NCGS诊断。•患有NCGS的患者是一个异质性群体，由几个亚组组成，每个亚组具有不同的发病机制、临床病史，可能还有临床病程。•婴儿期食物过敏个人史、并存的特应性、IgG抗麦醇溶蛋白抗体（AGA）阳性以及流式细胞术嗜碱性粒细胞活化试验，以及小麦和十二指肠和/或回肠 - 结肠上皮内和固有层嗜酸性粒细胞计数，可能有助于识别NCGS患者。•未来的研究应旨在确定用于NCGS诊断的可靠生物标志物，并更好地界定不同的NCGS亚组。
