Background: The aim of this study was to determine the occurrence of gluten sensitivity (GS) in a group of allergic patients and to assess the efficacy of a gluten-free diet (GFD) on the improvement of the symptomatology in those who were diagnosed with GS. Methods: 262 unrelated allergic patients with gastrointestinal symptoms of obscure origin were tested for GS condition by biopsy. All patients were also genotyped for the typical celiac DQ2 and DQ8 molecules and investigated for several hematological parameters such as antigliadin and antiendomysial antibodies. Patients displaying mucosal lesions were invited to follow a GFD. Results: Seventy-seven of the 262 allergic patients were positive to mucosal lesions, but negative to the antiAGA, antiEMA and to DQ2 and DQ8 molecules. We found, instead, a prevalence of the DQA1*05 allele, whereas anemia of inflammatory origin represented the predominant complaint in our subjects. The positive patients, who, after the GS diagnosis, followed a GFD, exhibited control of symptoms as well as stabilization of the hematological parameters even if allergic manifestations were not abated. Conclusions: A nonceliac gluten-sensitive enteropathy (NCGSE) commonly occurs in allergic patients. Based on the high prevalence of NCGSE in allergy, it is recommended that biopsy should be part of the routine investigation of allergic disease to offer the benefits of treatment with a GFD to the patients.

Keywords:
Nonceliac gluten-sensitive enteropathy, Allergy, DQA1*05, Inflammation, Anemia, Gluten-free diet
1.
Bevan S, Popat S, Braegger CP, Busch A, O’Donoghue D, Falth-Magnusson K, Ferguson A, Godkin A, Hogberg L, Holmes G, Hosie KB, Howdle PD, Jenkins H, Jewell D, Johnston S, Kennedy NP, Kerr G, Kumar P, Logan RF, Love AH, Marsh M, Mulder CJ, Sjoberg K, Stenhammer L, Walker-Smith J, Marossy AM, Houlston RS: Contribution of the MHC region to the familial risk of coeliac disease. J Med Genet 1999;36:687–690.
2.
Sollid LM: The molecular basis of coeliac disease. Annu Rev Immunol 2000;18:53–81.
3.
Karell K, Louka AS, Moodie SJ, Ascher H, Clot F, Greco L, Ciclitira PJ, Sollid LM, Partanen J, Members of the European Genetics Cluster on Celiac Disease: HLA types in celiac disease patients not carrying the DQA1*05-DQB1*02 (DQ2) heterodimer: results from the European Genetics Cluster on Celiac Disease. Hum Immunol 2003;64:469–477.
4.
Lundin KE, Scott H, Hansen T, Paulsen G, Halstensen TS, Fausa O, Thorsby E, Sollid LM: Gliadin-specific, HLA-DQ(A1*0501, B1*0201) restricted T cells isolated from the small intestinal mucosa of celiac disease patients. J Exp Med 1993;178:187–196.
5.
Molberg O, Kett K, Scott H, Thorsby E, Sollid LM, Lundin KE: Gliadin-specific HLA DQ2-restricted T cells are commonly found in small intestinal biopsies from coeliac disease patients, but not from controls. Scand J Immunol 1997;46:103–108.
6.
Nilsen EM, Lundin KE, Krajci P, Scott H, Sollid LM, Brandtzaeg P: Gluten specific, HLA-DQ restricted T cells from coeliac mucosa produce cytokines with Th1 or Th0 profile dominated by interferon-γ. Gut 1995;37:766–776.
7.
Green PH, Jabri B: Coeliac disease. Lancet 2003;362:383–391.
8.
Collin P, Reunala T, Pukkala E, Laippala P, Kerriainen O, Pasternack A: Coeliac disease-associated disorders and survival. Gut 1994;35:1215–1218.
9.
Schuppan D: Current concepts of celiac disease pathogenesis. Gastroenterology 2000;119:234–242.
10.
Del Prete G: Human Th1 and Th2 lymphocytes: their role in the pathogenesis of atopy. Allergy 1992;47:450–455.
11.
Williams AJ: Coeliac disease and allergic manifestations. Lancet 1987;1:808.
12.
Kero J, Gissler M, Hemminki E, Isolauri E: Could TH1 and TH2 diseases coexist? Evaluation of asthma incidence in children with coeliac disease, type 1 diabetes, or rheumatoid arthritis: a register study. J Allergy Clin Immunol 2001;108:781–783.
13.
Kelly CP, O’Shea B, Kelly J, Feighery C, Weir DG: Atopy in childhood coeliac disease. Lancet 1987;2:109.
14.
Zauli D, Grassi A, Granito A, Foderaro S, De Franceschi L, Ballardini G, Bianchi FB, Volta U: Prevalence of silent coeliac disease in atopics. Dig Liver Dis 2000;32:775–779.
15.
Greco L, de Seta L, D’Adamo G, Baldassarre C, Mayer M, Siani P, Lojodice D: Atopy and coeliac disease: bias or true relation? Acta Paed Scand 1990;79:670–674.
16.
Marsh MN: Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology 1992;102:330–354.
17.
Rostami K, Kerckhaert JP, Tiemessen R, Meijer JW, Mulder CJ: The relationship between anti-endomysium antibodies and villous atrophy in coeliac disease using both monkey and human substrate. Eur J Gastroenterol Hepatol 1999;11:439–442.
18.
Hayat M, Cairns A, Dixon MF, O’Mahony S: Quantitation of intraepithelial lymphocytes in human duodenum: what is normal? J Clin Pathol 2002;55:393–394.
19.
Imanishi T, Akaza T, Kimura A, Tokunaga K, Gojobori T: Allele and haplotype frequencies for HLA and complement loci in various ethnic group; in Tsuji K, Aizawa M, Sasazuki T (eds): HLA. Oxford, Oxford University Press, 1991, pp 1065–1220.
20.
Ciacci C, Cirillo M, Sollazzo R, Savino G, Sabbatini F, Mazzacca G: Gender and clinical presentation in adult celiac disease. Scand J Gastroenterol 1995;30:1077–1081.
21.
Nemeth E, Rivera S, Gabayan V, Keller C, Taudorf S, Pedersen BK, Ganz T: IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin. J Clin Invest 2004;113:1271–1276.
22.
Weiss G, Goodnough LT: Anemia of chronic disease. N Engl J Med 2005;352:1011–1023.
23.
Pittschieler K: Folic acid concentration in the serum and erythrocytes of patients with celiac disease. Pediatr Patol 1986;21:363–366.
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2011
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