Abstract
Historically, wheat and other gluten-containing grains have been an essential part of the diet of many people worldwide. However, the widespread use of gluten-containing products has led to an increased incidence of adverse reactions associated with their consumption, such as celiac disease and wheat allergy, as well as nonceliac gluten sensitivity, which has become common in recent years.
 Gluten-associated diseases have similar clinical manifestations (abdominal pain, bloating, diarrhea, nausea, and vomiting). The pathogenetic mechanisms underlying celiac disease and wheat allergy are quite well understood; in both cases, an immune response occurs when wheat proteins are consumed, both with effective treatment. Nonceliac gluten sensitivity is the subject of discussion; however, the processes underlying this disease are not fully understood; thus, its diagnosis and treatment have no unified approach. To date, nonceliac gluten sensitivity is a diagnosis of exclusion, which is established in the absence of markers of celiac disease or wheat allergy and improved following a gluten-free diet.
 A gluten-free diet is the most effective treatment for gluten-related diseases. However, like any other strict dietary restriction, gluten avoidance can result in reduced intakes of important nutrients, such as dietary fiber, protein, and micronutrients. In recent years, an increasing trend is found in the general population without confirmed gluten-related disorders that gluten-free product consumption or gluten-free diet adherence since gluten avoidance can improve well-being or gluten can be toxic for all human beings
 According to current guidelines, only patients diagnosed with celiac disease or wheat allergy are advised to follow a strict gluten-free diet.
 Herein, the modern conception of the immunopathology of gluten-related diseases and an overview of new potential therapies are presented.
Highlights
According to current guidelines only patients diagnosed with celiac disease or wheat allergy are advised to follow a strict gluten-free diet
Несмотря на схожесть клинической картины с аллергической реакцией на пшеницу (АНП) и целиакией, при обследовании лиц с нецелиакийной чувствительности к глютену (НЧГ) не выявляются ни специфические IgE, ни IgA к ТГ2, ни характерные для целиакии морфологические изменения тонкого кишечника [50]
Dieterich W., Schuppan D., Schink M., et al Influence of low FODMAP and gluten-free diets on disease activity and intestinal microbiota in patients with non-celiac gluten sensitivity // Clin Nutr
Summary
Аллергия к пшенице, нецелиакийная чувствительность к глютену - актуальные вопросы патогенеза и диагностики глютенассоциированных заболеваний. Однако широкое распространение глютенсодержащих продуктов привело к увеличению случаев побочных реакций, связанных с их потреблением, ― целиакии, аллергии на пшеницу, а также распространённой в последние годы нецелиакийной чувствительности к глютену. В то же время нецелиакийная чувствительность к глютену является предметом дискуссий, нет полного понимания процессов, лежащих в основе этого заболевания, и, соответственно, единого подхода к диагностике и лечению. На сегодняшний день нецелиакийная чувствительность к глютену является диагнозом исключения, который устанавливается при отсутствии маркеров целиакии или аллергии на пшеницу и улучшении самочувствия на фоне безглютеновой диеты. Только подтверждённый диагноз целиакии и аллергии на пшеницу является основанием для соблюдения строгой безглютеновой диеты.
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