Reese Imke, Schäfer Christiane, Kleine-Tebbe Jörg, Ahrens Birgit, Bachmann Oliver, Ballmer-Weber Barbara, Beyer Kirsten, Bischoff Stephan C, Blümchen Katharina, Dölle Sabine, Enck Paul, Enninger Axel, Huttegger Isidor, Lämmel Sonja, Lange Lars, Lepp Ute, Mahler Vera, Mönnikes Hubert, Ockenga Johann, Otto Barbara, Schnadt Sabine, Szepfalusi Zsolt, Treudler Regina, Wassmann-Otto Anja, Zuberbier Torsten, Werfel Thomas, Worm Margitta
Dietary Counseling and Nutrition Therapy with Specialization in Allergology, Ansprenger Str. 19, 80803 Munich, Germany.
Outpatient Center of Allergy and Pulmonology (Schwerpunktpraxis Collonaden), Dietary Counseling and Nutrition Therapy, Hamburg, Germany.
Allergo J Int. 2018;27(5):147-151. doi: 10.1007/s40629-018-0070-2. Epub 2018 May 28.
Within the last decade, non-celiac gluten/wheat sensitivity (NCGS) has been increasingly discussed not only in the media but also among medical specialties. The existence and the possible triggers of NCGS are controversial. Three international expert meetings which proposed recommendations for NCGS were not independently organized and only partially transparent regarding potential conflicts of interest of the participants. The present position statement reflects the following aspects about NCGS from an allergist's and nutritionist's point of view: (A) Validated diagnostic criteria and/or reliable biomarkers are still required. Currently, this condition is frequently self-diagnosed, of unknown prevalence and non-validated etiology. (B) Gluten has not been reliably identified as an elicitor of NCGS because of high nocebo and placebo effects. Double-blind, placebo-controlled provocation tests are of limited value for the diagnosis of NCGS and should be performed in a modified manner (changed relation of placebo and active substance). (C) Several confounders hamper the assessment of subjective symptoms during gluten-reduced or gluten-free diets. Depending on the selection of food items, e.g., an increased vegetable intake with soluble fibers, diets may induce physiological digestive effects and can modify gastrointestinal transit times independent from the avoidance of gluten. (D) A gluten-free diet is mandatory in celiac disease based on scientific evidence. However, a medically unjustified avoidance of gluten may bear potential disadvantages and risks. (E) Due to a lack of diagnostic criteria, a thorough differential diagnostic work-up is recommended when NCGS is suspected. This includes a careful patient history together with a food-intake and symptom diary, if necessary an allergy diagnostic workup and a reliable exclusion of celiac disease. We recommend such a structured procedure since a medically proven diagnosis is required before considering the avoidance of gluten.
在过去十年中，非乳糜泻性麸质/小麦敏感（NCGS）不仅在媒体上，而且在医学专业领域中都受到了越来越多的讨论。NCGS的存在及其可能的触发因素存在争议。三次提出NCGS建议的国际专家会议并非独立组织，且在参与者潜在利益冲突方面仅部分透明。本立场声明从过敏症专科医生和营养师的角度反映了关于NCGS的以下几个方面：（A）仍需要经过验证的诊断标准和/或可靠的生物标志物。目前，这种情况经常是自我诊断的，患病率未知且病因未经证实。（B）由于高反安慰剂效应和安慰剂效应，麸质尚未被可靠地确定为NCGS的诱发因素。双盲、安慰剂对照激发试验对NCGS诊断的价值有限，应采用改良方式进行（改变安慰剂与活性物质的比例）。（C）在减少麸质或无麸质饮食期间，有几个混杂因素会妨碍对主观症状的评估。根据食物的选择，例如增加蔬菜摄入量和可溶性纤维，饮食可能会引起生理消化效应，并可独立于避免麸质而改变胃肠道转运时间。（D）基于科学证据，乳糜泻患者必须采用无麸质饮食。然而，在医学上没有正当理由地避免食用麸质可能会带来潜在的不利因素和风险。（E）由于缺乏诊断标准，当怀疑有NCGS时，建议进行全面的鉴别诊断检查。这包括仔细询问患者病史以及食物摄入和症状日记，必要时进行过敏诊断检查，并可靠地排除乳糜泻。我们建议采用这种结构化程序，因为在考虑避免食用麸质之前需要有医学上证实的诊断。
