Wheat desensitization treatment in patients with gluten sensitivity

Gluten is the main structural protein of wheat and other cereals (barley, rye, etc.) and is one of the principal dietary components for most of the world population since the birth of agriculture, playing a key role in the development of human beings. On the other hand, this evolutionary trick has led to several diseases related to gluten exposure, the best studied of which is celiac disease (CD) and wheat allergy (WA). However, some individuals complain of gastrointestinal or extra-intestinal symptoms linked to the ingestion of gluten and disappearing with gluten withdrawal, even without any histological or serologic evidence of celiac disease (CD) or wheat allergy (FA). In most cases these patients consult a large number of physicians seeking the diagnosis of CD, but very often they are considered to be suffering from irritable bowel syndrome (IBS) only.
According to a recently developed consensus, the term “non-celiac gluten sensitivity” (NCGS) has been suggested for this condition, relating to “one or more of a variety of immunological, morphological or symptomatic manifestations that are induced by the ingestion of gluten in people in whom CD has been excluded” [1] and the diagnosis is possible only after exclusion of the celiac disease, food allergies or food-related disorders and the symptomatic response to a change in the diet [2]. The diagnostic “gold standard” for gluten sensitivity ought to be the double-blind placebo-controlled (DBPC) challenge, but it is a quite dangerous and time-consuming method and is therefore rarely used [3].
There are no objective findings or markers to support a diagnosis of gluten sensitivity and its pathogenesis remains obscure, although the hypothesis is based on a stimulation of the innate immune system by the gliadin. Another theory suggests that the gliadin induces a direct cytotoxic effect on enterocytes [4, 5]. However, a role for gluten proteins as the sole trigger of the associated symptoms remains to be established.
Although the patients with gluten sensitivity have a beneficial effect on their symptoms with the gluten-free diet, the same new diet reduces enormously their quality of life. For these reasons it is important not only to provide the understanding of the NCGS pathogenesis, but also how to manage this disease to enhance the quality of life of the patients.
Therefore, we present a case report about a girl with NCGS who underwent successful wheat desensitization...


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