Non-Celiac Wheat Sensitivity Is Not a New Entity

Abstract

To the Editor: Carroccio et al. (1) have performed an excellent study and contributed to the differential diagnosis between celiac disease and gluten sensitivity. However, the title of their article is not entirely correct as they have claimed to have explored “a new clinical entity”. In 1980, Trevor Cooke's group in Birmingham, UK, described very clearly patients with gluten-sensitive diarrhea without evidence of celiac disease (2). We have observed children and adult patients with chronic diarrhea, bloating, abdominal pain, nausea, headaches, with normal small intestinal biopsy specimens, and absence of celiac disease antibodies who responded dramatically to a gluten-free diet. At the present time, it seems that non-celiac wheat or gluten sensitivity may not be an entity but a syndrome as there is some evidence that the pathogenesis of this non-celiac gluten sensitivity is diverse in different patients. It is clear that few children and adults may suffer from gluten allergy where immunoglobulin-E is involved, but in the rest of the patients the intolerance may be manifested by abnormal permeability and abnormalities in the innate immunity (3,4) and yet another group by intolerance to other components of wheat and not related to the presence of celiac-toxic peptides (5).