Characteristics of gluten related disorders

In the recent years gluten ingestion has been linked with a range of clinical disorders. Gluten-related disorders have gradually emerged as an epidemiologically relevant phenomenon with an estimated global prevalence around 5%.

Gluten-related disorders (GRDs) are characterized by abnormal immunological responsiveness to ingested gluten in genetically susceptible individuals. Gluten proteins are present in wheat, barley, and rye. GRDs are heterogeneous, reflecting their autoimmune, allergic, and non-autoimmune-allergic etiology.

The most common general symptoms of GRDs include bloating, abdominal pain, constipation, diarrhea, headache, tingling and numbness in hands and feet, fatigue and joint pain.

Celiac disease (CD), dermatitis herpetiformis (DH), gluten ataxia (GA), wheat allergy (WA), and non-celiac gluten sensitivity (NCGS) are the five major GRDs that present with a wide range of clinical manifestations.

Celiac disease
Celiac disease (CD) is the most prominent autoimmune gluten-related disorder. The ingestion of gluten in genetically predisposed individuals carrying HLA type Ⅱ DQ2/DQ8 alleles can arouse a T-cell mediated immune reaction against tissue transglutaminase, an enzyme of the extracellular matrix, leading to mucosal damage and eventually to intestinal villous atrophy.

When celiac disease patients follow a gluten-free diet, the normal architecture of the intestinal villi is restored and the skin lesions heal.

Dermatitis herpetiformis
Dermatitis herpetiformis (DH), also known as Duhring disease, is the cutaneous counterpart of CD (“skin CD”).

Dermatitis Herpetiformis (DH) is a chronic, autoimmune, and recurrent cutaneous-intestinal disorder identified in genetically susceptible individuals, which is often associated with celiac disease. Anti tTG (anti-tissue transglutaminase) antibodies that are produced in response to gluten exposure can also recognize epidermal transglutaminase (ETG).

Gluten ataxia
Gluten ataxia (GA) is a form of cerebellar ataxia, affecting mainly Purkinje cells, and is caused by antibodies released when digesting gluten that mistakenly attacks part of the brain in individuals that are sensitive and genetically susceptible.

Wheat allergy
An IgE and non-IgE mediated immune response characterize wheat allergy (WA), resulting in an allergic reaction in some individuals upon contact, inhalation, or uptake of foods containing wheat but not necessarily other grains as barley or rye.

Wheat allergy is classified into occupational asthma (baker’s asthma) and rhinitis; food allergy (FA), affecting the skin, the gastrointestinal tract or the respiratory tract; wheatdependent exercise-induced anaphylaxis (WDEIA) and contact urticaria. Ingested wheat can cause IgEmediated wheat allergies in both children and adults.

Non-celiac gluten sensitivity
Non-celiac wheat/gluten sensitivity (NCWGS) makes people experience symptoms similar to CD and WA. However, patients with NCWGS do not have specific IgE against wheat proteins or IgA anti-TG2 autoantibodies.
Characteristics of gluten related disorders

Buckwheat allergy

Buckwheat is unusually high in protein and provides riboflavin, niacin, copper and magnesium.  In Japan, buckwheat has long been used in the form of soba noodles, though these typically are combined with wheat.

Buckwheat seems to be a common food trigger to induce anaphylaxis in both Korea and Japan, where noodles made of buckwheat are commonly eaten.

Buckwheat like wheat can be not only a food allergen but also aeroallergen, especially for workers in buckwheat noodle factories.

It was reported three cases of buckwheat flour allergy in children using buckwheat chaff-stuffed pillows, who had been treated as nonatopic asthmatics after undergoing the routine allergy skin and serologic tests.

 The result showed that small amount of buckwheat flour attached to buckwheat chaff-stuffed pillow can induce buckwheat flour sensitization and buckwheat chaff-stuffed pillow should be considered a main cause of childhood nocturnal asthma in these asthmatics exposed to these pillows (Lee, S.Y, Lee., K.S Hong, C.H and Lee, K.Y (2001) Three cases of childhood nocturnal asthma due to buckwheat allergy, Allergy, 56: 763-766).

As buckwheat is now becoming a common food in countries such as the USA and France, one might suspect a progression of buckwheat allergy through the world.

Clinically symptomatic patients with buckwheat allergy usually show strong skin reactivity and high levels of specific IgE to buckwheat. Most allergic symptoms’ to buckwheat are objective manifestations such as urticaria, asthma symptoms and hypotension, among others.
Buckwheat allergy