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Non-celiac wheat sensitivity as an allergic condition

This month's issue of the American Journal of Gastroenterology examines non-celiac wheat sensitivity as an allergic condition.

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Non-celiac wheat sensitivity (NCWS) is a newly described clinical entity characterized by symptoms, which can involve the gastrointestinal tract, the nervous system, the skin, and other organs.

There is little data on the pathogenesis of non-celiac wheat sensitivity and it is probable that different pathogenic mechanisms are involved in the different clinical manifestations of the disease.

The only common denominator of non-celiac wheat sensitivity 'syndrome' is wheat consumption, where the symptoms disappear on exclusion of wheat from the diet, and reappear on wheat consumption.

Dr Antonio Carroccio and colleagues from Italy reviewed the prior data regarding non-celiac wheat sensitivity, and reviewed relevant medical literature regarding non-celiac wheat sensitivity.

The team paid particular attention to the hypothesis that non-celiac wheat sensitivity patients could suffer from non-immunoglobulin E (IgE)-mediated wheat allergy.

The researchers reviewed our data on 276 patients diagnosed with non-celiac wheat sensitivity by means of double-blind placebo-controlled (DBPC) wheat challenge.

The data indicating a possible wheat allergy diagnosis were examined and other data in the literature were reviewed.

Non-celiac wheat ensitivity was characterized by coexistent atopic disease
American Journal of Gastroenterology

The research team reviewed the role of serum immunoglobulin G antibodies and the basophil activation assay in food allergy, and the histology findings in the food allergy diagnosis.

The team compared patients suffering from non-celiac wheat sensitivity and presenting with irritable bowel syndrome (IBS), and controls with IBS not due to non-celiac wheat sensitivity.

The team observed that non-celiac wheat sensitivity was characterized by a personal history of food allergy in the pediatric age, coexistent atopic disease, positive serum anti-gliadin and anti-betalactoglobulin antibodies, positive cytofluorimetric assay revealing in vitro basophil activation by food antigens, and a presence of eosinophils in the intestinal mucosa biopsies.

Dr Carroccio's team concludes, "Patients with non-celiac wheat sensitivity and multiple food sensitivity show several clinical, laboratory, and histological characteristics that suggest they might be suffering from non-IgE-mediated food allergy."

"However, other pathogenic mechanisms need to be considered."

Am J Gastroenterol 2013; 108:1845–1852
06 December 2013

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