Gluten-related disorders is the term for the diseases triggered by gluten, including coeliac disease (CD), non-celiac gluten sensitivity (NCGS), gluten ataxia, dermatitis herpetiformis (DH) and wheat allergy. The umbrella category has also been referred to as gluten intolerance, though a multi-disciplinary physician-led study, based in part on the 2011 International Coeliac Disease Symposium, concluded that the use of this term should be avoided due to a lack of specificity. Gluten is a group of proteins, such as prolamins and glutelins, stored with starch in the endosperm of various cereal (grass) grains. As of 2017, gluten-related disorders were increasing in frequency in different geographic areas. The increase might be explained by the popularity of the Western diet, the expanded reach of the Mediterranean diet (which also includes grains with gluten), the growing replacement of rice by wheat in many countries, the development in recent years of new types of wheat with a higher amount of cytotoxic gluten peptides, and the higher content of gluten in bread and bakery products, due to the reduction of dough fermentation time. However, a 2020 study by the Leibniz-Institute for Food Systems Biology casts doubt on the idea that modern wheat has higher gluten levels. From a seed bank, they grew and analyzed 60 wheat cultivars from between 1891 and 2010 and found no changes in albumin/globulin and gluten contents over time. "Overall, the harvest year had a more significant effect on protein composition than the cultivar. At the protein level, we found no evidence to support an increased immunostimulatory potential of modern winter wheat."
Types The following classification of gluten-related disorders was announced in 2011 by a panel of experts in London, and published in February 2012:
Autoimmune disorders: celiac disease, dermatitis herpetiformis, gluten ataxia Non-autoimmune, non-allergic: disorder with unknown cause, likely immune-modulated: non-celiac gluten sensitivity (NCGS) Allergic: food allergy (IgE-mediated and non-IgE-mediated), wheat dependent exercise induced anaphylaxis (WDEIA), baker's asthma, contact dermatitis.
Autoimmune disorders
Autoimmune conditions related to gluten include celiac disease, dermatitis herpetiformis, and gluten ataxia. There is research showing that in people with gluten ataxia early diagnosis and treatment with a gluten-free diet can improve ataxia and prevent its progression. The population of people with gluten ataxia and other neurological conditions appears to have a different HLA distribution, in particular more HLA-DQ1, compared to most persons with celiac disease, who have HLA-DQ2 and HLA-DQ8.
Coeliac disease
Coeliac disease (American English: celiac) (CD) is one of the most common chronic, immune-mediated disorders, triggered by the eating of gluten, a mixture of proteins found in wheat, barley, rye, and derivatives. Evidence has shown that this condition not only has an environmental component but a genetic one as well, due to strong associations of CD with the presence of HLA (Human leukocyte antigen) type II, specifically DQ2 and DQ8 alleles. These alleles can stimulate a T cell, mediated immune response against tissue transglutaminase (TTG), an enzyme in the extracellular matrix, leading to inflammation of the intestinal mucosa and eventually villous atrophy of the small intestine. This is where the innate and adaptive immune response systems collide.
CD is not only a gastrointestinal disease. It may involve several organs and cause an extensive variety of non-gastrointestinal symptoms. Most importantly, it may often be completely asymptomatic. Added difficulties for diagnosis are the fact that serological markers (anti-tissue transglutaminase [TG2]) are not always present and many people may have minor mucosal lesions, without atrophy of the intestinal villi. Diagnosis of CD should be based on a combination of person's familial history, genetics (i.e. presence of HLA DQ2/DQ8) serology and intestinal histology. CD affects approximately 1–2% of general population all over the world, but most cases remain unrecognized, undiagnosed and untreated, and exposed to the risk of long-term complications. People may experience severe disease symptoms and be subjected to extensive investigations for many years before a proper diagnosis is achieved. Untreated CD may result in the lack of absorption of nutrients, reduced quality of life, iron deficiency, osteoporosis, an increased risk of intestinal lymphomas and greater mortality. CD is associated with some autoimmune diseases, such as diabetes mellitus type 1, thyroiditis, gluten ataxia, psoriasis, vitiligo, autoimmune hepatitis, dermatitis herpetiformis, primary sclerosing cholangitis, and more. CD with "classic symptoms", which include gastrointestinal manifestations such as chronic diarrhea and bloating, malabsorption of certain vitamins and minerals, loss of appetite, impaired growth and even bone pain, is currently the least common presentation form of the disease. It predominantly affects small children, generally younger than two years of age. CD with "non-classic symptoms" is the most common type clinically found, occurring in children over two years old, adolescents, and adults. It is characterized by milder or even absent gastrointestinal symptoms alongside a wide spectrum of non-intestinal manifestations that can involve any organ of the body. Some examples include cerebellar ataxia, hypertransaminasemia and peripheral neuropathy. As previously mentioned, CD very frequently may be completely asymptomatic both in children (at least in 43% of the cases) and adults. To date, the only available medically accepted treatment for people with coeliac disease is to follow a lifelong gluten-free diet. With continuous mass genetic modification of grain crops, for reasons such as resistance to drought and pests, the occurrence of diagnosed CD had increased by 400% in the past 50 years alone.
Dermatitis herpetiformis
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