Wheat Ingestion Research Articles

Pathogenesis of Celiac Disease and Other Gluten Related Disorders in Wheat and Strategies for Mitigating Them.

Wheat is a major cereal crop providing energy and nutrients to the billions of people around the world. Gluten is a structural protein in wheat, that is necessary for its dough making properties, but it is responsible for imparting certain intolerances among some individuals, which are part of this review. Most important among these intolerances is celiac disease, that is gluten triggered T-cell mediated autoimmune enteropathy and results in villous atrophy, inflammation and damage to intestinal lining in genetically liable individuals containing human leukocyte antigen DQ2/DQ8 molecules on antigen presenting cells. Celiac disease occurs due to presence of celiac disease eliciting epitopes in gluten, particularly highly immunogenic alpha-gliadins. Another gluten related disorder is non-celiac gluten-sensitivity in which innate immune-response occurs in patients along with gastrointestinal and non-gastrointestinal symptoms, that disappear upon removal of gluten from the diet. In wheat allergy, either IgE or non-IgE mediated immune response occurs in individuals after inhalation or ingestion of wheat. Following a life-long gluten-free diet by celiac disease and non-celiac gluten-sensitivity patients is very challenging as none of wheat cultivar or related species stands safe for consumption. Hence, different molecular biology, genetic engineering, breeding, microbial, enzymatic, and chemical strategies have been worked upon to reduce the celiac disease epitopes and the gluten content in wheat. Currently, only 8.4% of total population is affected by wheat-related issues, while rest of population remains safe and should not remove wheat from the diet, based on false media coverage.

Wheat-dependent Exercise-induced Anaphylaxis

Gluten-related disorders are an emerging worldwide with a global prevalence estimated at 5% in the general population. They include celiac disease, nonceliac gluten sensitivity and wheat allergy. Specifically, the peculiar wheat-dependent exercise-induced anaphylaxis is a particular allergy that occurs after wheat ingestion followed by physical exercise.

Gluten Detection Methods and Their Critical Role in Assuring Safe Diets for Celiac Patients.

Celiac disease, wheat sensitivity, and allergy represent three different reactions, which may occur in genetically predisposed individuals on the ingestion of wheat and derived products with various manifestations. Improvements in the disease diagnostics and understanding of disease etiology unveiled that these disorders are widespread around the globe affecting about 7% of the population. The only known treatment so far is a life-long gluten-free diet, which is almost impossible to follow because of the contamination of allegedly “gluten-free” products. Accidental contamination of inherently gluten-free products could take place at any level from field to shelf because of the ubiquity of these proteins/grains. Gluten contamination of allegedly “gluten-free” products is a constant threat to celiac patients and a major health concern. Several detection procedures have been proposed to determine the level of contamination in products for celiac patients. The present article aims to review the advantages and disadvantages of different gluten detection methods, with emphasis on the recent technology that allows identification of the immunogenic-gluten peptides without the use of antibodies. The possibility to detect gluten contamination by different approaches with similar or better detection efficiency in different raw and processed foods will guarantee the safety of the foods for celiac patients.

Risk assessment of contaminants of emerging concern in the context of wastewater reuse for irrigation: An integrated modelling approach.

Direct reuse of reclaimed wastewater (RWW) in agriculture has recently received increasing attention as a possible solution to water scarcity. The presence of contaminants of emerging concern (CECs) in RWW can be critical, as these chemicals can be uptaken in irrigated crops and eventually ingested during food consumption. In the present study, an integrated model was developed to predict the fate of CECs in water reuse systems where RWW is used for edible crops irrigation. The model was applied to a case study where RWW (originating from a municipal wastewater treatment plant) is discharged into a water channel, with subsequent irrigation of silage maize, rice, wheat and ryegrass. Environmental and human health risks were assessed for 13 CECs, selected based on their chemical and hazard characteristics. Predicted CEC concentrations in the channel showed good agreement with available measurements, indicating potential ecotoxicity of some CECs (estrogens and biocides) due to their limited attenuation. Plant uptake predictions were in good agreement with existing literature data, indicating higher uptake in leaves and roots than fruits. Notably, high uncertainties were shown for weakly acidic CECs, possibly due to degradation in soil and pH variations inside plants. The human health risk due to the ingestion of wheat and rice was assessed using the threshold of toxicological concern and the hazard quotient. Both approaches predicted negligible risk for most CECs, while sulfamethoxazole and 17α-ethinylestradiol exhibited the highest risk for consumers. Alternative scenarios were evaluated to identify possible risk minimization strategies (e.g., adoption of a more efficient irrigation system).

Effect of Rice, Wheat, and Mung Bean Ingestion on Intestinal Gas Production and Postprandial Gastrointestinal Symptoms in Non-Constipation Irritable Bowel Syndrome Patients.

The aim of this study is to evaluate the effect of rice, mung bean, and wheat noodle ingestion on intestinal gas production and postprandial gastrointestinal (GI) symptoms in non-constipation irritable bowel syndrome (IBS) patients. Methods: Twenty patients (13 F, 46 ± 11 y) underwent 8 h breath test studies and GI symptom evaluations after standard rice, wheat, or mung bean noodle meals at 8:00 a.m. in a randomized crossover study with a 1-week washout period. The same meal was ingested at 12:00 p.m. Results: The H2 and CH4 concentration in the breath samples were similar at baseline (rice:wheat:mung bean, H2 = 3.6 ± 0.5:4.1 ± 0.5:4.0 ± 0.7 ppm, CH4 = 1.3 ± 0.3:2.1 ± 0.4:1.9 ± 0.4 ppm, p > 0.05). Beginning at the fifth hour after breakfast, H2 and CH4 concentrations significantly increased after wheat compared to rice and mung bean (8 h AUC H2 = 4120 ± 2622:2267 ± 1780:2356 ± 1722, AUC CH4 = 1617 ± 1127:946 ± 664:943 ± 584 ppm-min, respectively) (p < 0.05). Bloating and satiety scores significantly increased after wheat compared to rice (p < 0.05), and increased but did not reach statistical significance compared to mung bean (p > 0.05). A higher bloating score after wheat compared to rice and mung bean was observed clearly after lunch but not after breakfast. Conclusion: Wheat ingestion produced more intestinal gas and more bloating and satiety scores compared to rice and mung bean, especially after lunch. This provides insight into the role of intestinal gas in the development of bloating symptoms in IBS.

Wheat‐dependent exercise‐induced anaphylaxis in Chinese people: a clinical research on 33 cases with antigenic analysis of wheat proteins

Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a severe allergic condition in which wheat ingestion together followed by physical exercise induces anaphylaxis. For patients with WDEIA, omega-5 gliadin is considered to be one of the major allergens. To analyse the clinical features and allergen spectrum of WDEIA and to investigate the relationship between WDEIA and serum levels of platelet-activating factor (PAF), interleukin (IL)-9 and IL-33. Medical histories and conditions of WDEIA cases were collected and summarized, with allergen tests of wheat proteins measured at the same visit. Of the 33 patients enrolled, 13 also had serum levels of PAF, IL-9 and IL-33 measured. The healthy control (HC) group consisted of 13 healthy individuals, who also underwent both the wheat-protein allergen tests and the inflammatory-mediator tests. All patients experienced severe allergic reaction during exercise after wheat ingestion. Manifestations of WDEIA included facial oedema, generalized urticaria and respiratory symptoms. Unconsciousness was also observed in 21 cases. In the patient group, 57.6% were confirmed as hypersensitive to glyceraldehyde-3-phosphate dehydrogenase (GAPDH), while 54.5% were allergic to omega-5 gliadin. PAF concentration was significantly higher in patients with WDEIA compared with HCs, whereas there was no significant difference in IL-9 or IL-33 between the two groups. WDEIA is a rare type of anaphylaxis. GAPDH and omega-5 gliadin may be the most common allergy-causing wheat proteins for Chinese people. PAF may be associated with the onset and development of WDEIA.

English

Wheat ingestion can lead to disorders such as IgE-mediated food allergy and wheat-dependent exercise-induced anaphylaxis (WDEIA), both of which are associated with impaired quality of life and significant morbidity. Allergy to wheat is relatively benign in children, although its natural history in adults is still unknown. Objective: We used placebo-controlled challenge to evaluate the natural history of wheat hypersensitivity in atopic patients with adultonset wheat allergy.We enrolled 13 patients from an initial cohort of adult patients with IgE-mediated wheat allergy (mean age, 40 years). After diagnosis, the patients observed a wheat-free diet and were followed as outpatients for 5 years to evaluate wheat exposure. Wheat-IgEtiters were determined at the end of follow-up, and a second wheat-challenge was performed.Ten out of 13 patients took part in the study. The mean period of wheat avoidance was 4.2 years. Three patients had spontaneously reintroduced wheat before the second evaluation, after a mean (IQR) of 28 (18-36) months, with only mild gastrointestinal discomfort at reintroduction. At the end of follow-up, 9 of the 10 patients were wheat-tolerant. Two patients had a history of WDEIA. We observed a reduction in IgE levels, with median (IQR) IgE falling from 2.77 (0.35-100) kU/L at diagnosis to 0.88 (0.1-20.8) kU/L. The association between IgE and a negative challenge result was not statistically significant.IgE-mediated wheat allergy in adults is benign and represents a temporary break in gastrointestinal tolerance. Future studies may improve our knowledge of wheat allergens, routes of and factors leading to sensitization, and prognostic biomarkers.

Health risk assessment of Pb and Cd in soil, wheat, and barley in Shazand County, central of Iran.

Heavy metal contamination via mining activity is a serious problem around the world. This study was conducted to evaluate the total non-cancer hazard quotient (THQ) and excess lifetime cancer risks of lead (Pb) and cadmium (Cd) to different population groups via soil, wheat and barley ingestion, soil-dermal contact, and inhalation soil particulates around Shahin mine located in Shazand County. Soil and plants were sampled randomly from 60 agricultural fields around Shahin mine. The samples Pb and Cd concentrations were determined using atomic absorption spectroscopy (AAS). The THQ and the excess lifetime cancer risks of Pb and Cd were estimated using the formulas suggested by the U.S. Environmental Protection Agency (USEPA). The Pb non-cancer risk for children (<6years old) was assessed using the integrated exposure uptake bio-kinetic (IEUBK) model. The mean contents of Pb (234.47mgkg-1) and Cd (1.89mgkg-1) in soil samples were higher than the background values. The mean Pb and Cd concentrations in wheat grains were 0.44 and 0.23μgg-1 respectively, which were about 6.5 and 5.8 times higher than that was observed in barley grains, respectively. The THQ of Pb and Cd for all groups were greater than 1. The excess lifetime cancer risks of Pb via wheat and barley consumption for all receptor groups were greater than 1 × 10-6. Crop ingestion and soil inhalation had the greatest and lowest portions to increase the THQ and excess lifetime cancer risks of Pb and Cd in the study region, respectively.

Assessment of the human health risks of heavy metals in nine typical areas.

Human health risks of five different heavy metals were assessed in nine typical areas in Asia, Europe, and Africa. The geoaccumulation index (Igeo) of arsenic (As) in Hyderabad (HB), cadmium (Cd) in Veles (VL), and lead (Pb) in Murcia (MC) were found to be 5, indicating extreme contamination. This is related to their high concentrations in soil. The concentration of As in wheat in Niger Delta (ND) and European Union (EU) areas were 3.3 and 2.55mg/kg, which were 22 and 17 times respectively of the World Health Organization (WHO)/Food and Agriculture Organization (FAO) criteria. In general, the concentrations of heavy metals in wheats were higher than those in corns, indicating that heavy metals were easier to accumulate in wheats than in corns. The human risks induced by the carcinogenic metals As and Cd were much higher than those induced by noncarcinogenic metals in different exposure ways. The human health risks of heavy metals in different exposure ways were Rw-ing > Rc-ing > Rs-ing > Rs-der > Rs-inh. The human health risks induced by wheat ingestion for adults and children accounted for 67.75-97.52% and 69.52-98.04%, respectively, of the total human health risks. The total human health risks in the VL and MC areas were 1.58 × 10-4 a-1 and 1.3 × 10-4 a-1 for adults and 1.14 × 10-4 a-1 and 9.47 × 10-5 a-1 for children, respectively, which were significantly high according to the Environmental Protection Agency and International Commission on Radiological Protection. The ranking of the total human health risks in different areas were RVL > RMC > RND > REU > RHB > RKY > RTB > RMLV>RNHM. The total human health risks of adults were higher than those of children.

Non-celiac wheat sensitivity: a search for the pathogenesis of a self-reported condition

A significant percentage of the general population reports gastrointestinal and non-gastrointestinal symptoms caused by wheat and/or gluten ingestion, even though they do not suffer from celiac disease (CD) or wheat allergy (WS), because they test negative both for CD-specific serology and histopathology. All patients report improvement of symptoms on a gluten-free diet. This clinical condition has been named non-celiac gluten sensitivity (NCGS). The objective of this paper was to review some studies regarding the pathogenesis of NCGS to summarize the current hypotheses about the mechanisms, which can lead to NCGS. Particular attention was given to the immunologic and the malabsorptive hypotheses. We reviewed data of our previous studies involving patients diagnosed with NCWS by means of double-blind placebo-controlled wheat challenge. The data indicating a possible wheat allergy diagnosis were examined and other data in the literature were reviewed; we also reviewed the putative role of fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAPs) and of α-amylasetrypsin inhibitors (ATIs) proteins in the NCGS pathogenesis. NCGS pathogenesis has been attributed to very different mechanisms, among others: i) activation of innate and adaptive immunity (the immune/allergic mechanisms) induced by gluten or the non-gluten ATI family; ii) incomplete digestion and/or absorption of FODMAPs (the intolerance mechanisms); and iii) psychological effect.We suggest that NCGS is a heterogeneous condition, which includes different subgroups of patients who have different pathogenic mechanisms: strong data suggest a direct pathogenic immunogenic/inflammatory role of wheat-cereal proteins (not only gluten) in a subgroup, probably the largest, of these patients.

ADULT-ONSET WHEAT ANAPHYLAXIS IN THE POSTPARTUM PERIOD

Introduction Although most food allergies present in childhood, food allergies can develop at any age. The lay press suggests the occurrence of new allergy following parturition, but this has not been well-documented in the literature. Case Description 37-year old female without prior food allergies presented with sudden-onset urticaria, one week postpartum, which resolved with epinephrine. Over the subsequent two weeks, she had two episodes of anaphylaxis, during walks preceded by wheat ingestion. Per the patient's report, ingestion of wheat without exercise did not provoke symptoms. Skin testing shortly thereafter to a panel of aeroallergens and food allergens was negative. Serum specific IgE testing and component-resolved diagnostics were significant only for wheat omega-5 gliadin (5.3 ISU-E). An open challenge to wheat was positive with urticaria. We recommended strict avoidance of wheat. On follow up in 4 years, she had had no further allergic reactions and continued to avoid wheat. Omega-5 gliadin sensitization has declined slightly over these four years, to 2.1 ISU-E. She has not been re-challenged to wheat. Discussion Recent anaphylaxis may yield falsely-negative skin test results. This patient's initial history was suggestive of food-dependent, exercise-induced anaphylaxis (FDEIA). Wheat sensitization, specifically omega-5 gliadin, is the most commonly reported sensitization and trigger in FDEIA. Although exercise was a previously required component of her reactions, our patient developed subsequently a reaction during the open challenge, which was at rest. Striking in this case was the development of new food allergy closely associated with parturition. Pregnancy could modify food allergy risk.

A New Diagnostic Criteria of Wheat-Dependent, Exercise-Induced Anaphylaxis in China

Background:Wheat-dependent, exercise-induced anaphylaxis (WDEIA) is an allergic reaction induced by intense exercise combined with wheat ingestion. The gold standard for diagnosis of WDEIA is a food exercise challenge; however, this test is unacceptable for Chinese WDEIA patients and unable to be approved by the Ethics Committee of Chinese hospitals due to substantial risk. There are no diagnostic criteria for Chinese WDEIA patients. The aim of present study was to propose new practical diagnosis criteria for Chinese WDEIA patients.Methods:We prospectively included 283 clinically diagnosed WDEIA patients from January 1, 2010 to June 30, 2014, and in the meanwhile, three groups were enrolled which included 133 patients with the history of anaphylaxis induced by food other than wheat, 186 recurrent urticaria patients, and 94 healthy participants. Clinical comprehensive evaluation by allergists used as the reference gold standard, receiver operator characteristic (ROC) curves were plotted, areas under curve (AUC) for specific immunoglobin E (sIgE) were compared to evaluate the diagnostic value of IgE specific to wheat, gluten, and ω-5 gliadin. Patients were followed up by telephone questionnaire 1 year after diagnosis.Results:We reviewed 567 anaphylactic reactions in 283 WDEIA patients. Of these anaphylactic reactions, 415 (73.3%) reactions were potentially life-threatening anaphylaxis. Among the 567 anaphylactic reactions, 75% (425/567) occurred during exercise. The highest AUC (0.910) was observed for sIgE for gluten, followed by omega-5 gliadin (AUC 0.879). Combined gluten- and ω-5 gliadin-specific IgE testing provided sensitivity and specificity of 73.1% and 99.0%, respectively. During the 1-year follow-up period, repeat anaphylaxis was rare when patients observed strict avoidance of wheat products combined with exercise or other triggering agents.Conclusions:In this study, we proposed diagnostic criteria and management of WDEIA patients in China. Our present study suggested that confirmed anaphylactic reactions triggered by wheat with positive sIgE to gluten and omega-5-gliadin may provide supportive evidence for clinicians to make WDEIA diagnosis without performing a food exercise challenge.

Wheat-Dependent Cofactor-Augmented Anaphylaxis: A Prospective Study of Exercise, Aspirin, and Alcohol Efficacy as Cofactors

Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a severe and potentially life-threatening allergy caused by wheat ingestion and most commonly in combination with exercise. To investigate the role and impact of different cofactors (exercise, aspirin, and alcohol) in patients with WDEIA. We studied 25 adult patients with WDEIA. Diagnostic workup included specific IgE to omega-5 gliadin and skin prick test with wheat flour and gluten. Titrated oral challenge was performed with gluten at rest, combined with treadmill exercise, aspirin, alcohol, or a combination of exercise and aspirin. A positive challenge to gluten was found at rest (without cofactors) in 48% (12 of 25), with exercise in 92% (23 of 25), with aspirin in 84% (21 of 25), with alcohol in 56% (9 of 19), and with a combination of exercise and aspirin in 82% (18 of 22) of the patients. With exercise as a cofactor, the median threshold was 24 g (range, 4.8-80 g), with aspirin 8 g (range, 2.4-80 g), and with alcohol 28 g (range, 0-45 g). The combination of 2 cofactors (exercise and aspirin) resulted in a median threshold of 4.3 g (range, 1.1-48 g). The threshold for the clinical reaction was lowered by 63%, 83%, 36%, and 87%, respectively, compared with at rest. The mean severity grade (scale 0-5) according to the Sampson severity score at rest was 0.8 (range, 0-2), and when combined with exercise 2.1 (range, 0-5), with aspirin 1.9 (range, 0-5), with alcohol 0.8 (range, 0-2), and with the combination of exercise and aspirin 1.5 (range, 0-2). Our results demonstrate that exercise and aspirin augment clinical reactions in WDEIA by lowering the threshold and increase the severity of the allergic reaction, whereas alcohol gives ambiguous results. Furthermore, a combination of 2 cofactors (exercise and aspirin) increases therisk of reactions.

Wheat Intolerance and Chronic Gastrointestinal Symptoms in an Australian Population-based Study: Association Between Wheat Sensitivity, Celiac Disease and Functional Gastrointestinal Disorders.

Wheat avoidance in the absence of celiac disease (CD) is common but occurrence of concurrent functional gastrointestinal disorders (FGIDs) in this group is uncertain. The aims of this study were to determine the prevalence of self-reported wheat or gluten sensitivity and doctor diagnosed CD in an Australian population, define the associated gastrointestinal (GI) symptoms and FGIDs, and determine the relationship between self-reported wheat sensitivity, demographic and medical factors. A total of 3542 people randomly selected from the Australian population returned a mail survey which contained questions on wheat avoidance, GI symptoms, demographic, medical, and lifestyle factors. We defined self-reported wheat sensitivity as people who reported gastrointestinal symptoms on ingestion of wheat based foods, but did not suffer from celiac disease, inflammatory bowel disease or colorectal cancer. Functional dyspepsia (FD) and irritable bowel syndrome (IBS) were diagnosed by Rome III criteria. CD status was self-reported. The prevalence of self-reported wheat sensitivity in this cohort was 14.9% (95% CI 13.7-16.2). The prevalence of CD was 1.2% (95%CI 0.8-1.6). Doctor diagnosed CD was significantly associated with a diagnosis of FD (OR 3.35, 95%CI 1.72-6.52) and IBS (OR 2.28, 95%CI 1.08-4.81). Those with self-reported wheat sensitivity were more likely to report multiple abdominal symptoms (of the 18 assessed) than those without (3.9 symptoms with self-reported wheat sensitivity vs. 1.6 without, p = 0.0001). In a multivariate analysis, self-reported wheat sensitivity was independently associated with IBS (OR 3.55, 95%CI 2.71-4.65) and FD (1.48, 95%CI 1.13-1.94). Self-reported wheat sensitivity is common, with a prevalence of 14.9% in this cohort. There is a strong association between both celiac disease and self-reported wheat sensitivity, and chronic gastrointestinal symptoms, as well as a diagnosis of FD and IBS.

Alterations in the Gut (Gallus gallus) Microbiota Following the Consumption of Zinc Biofortified Wheat (Triticum aestivum)-Based Diet

The structure and function of cecal microbiota following the consumption of a zinc (Zn) biofortified wheat diet was evaluated in a well-studied animal model of human nutrition ( Gallus gallus) during a six-week efficacy trial. Using 16S rRNA gene sequencing, a significant increase in β- but not α-microbial diversity was observed in the animals receiving the Zn biofortified wheat diet, relative to the control. No significant taxonomic differences were found between the two groups. Linear discriminant analysis revealed a group of metagenomic biomarkers that delineated the Zn replete versus Zn deficient phenotypes, such that enrichment of lactic acid bacteria and concomitant increases in Zn-dependent bacterial metabolic pathways were observed in the Zn biofortified group, and expansion of mucin-degraders and specific bacterial groups able to participate in maintaining host Zn homeostasis were observed in the control group. Additionally, the Ruminococcus genus appeared to be a key player in delineating the Zn replete microbiota from the control group, as it strongly predicts host Zn adequacy. Our data demonstrate that the gut microbiome associated with Zn biofortified wheat ingestion is unique and may influence host Zn status. Microbiota analysis in biofortification trials represents a crucial area for study as Zn biofortified diets are increasingly delivered on a population-wide scale.

Radiological Assessment of the Artificial and Natural Radionuclide Concentrations of Wheat and Barley Samples in Karbala, Iraq

Introduction: Artificial and natural radionuclides exist in the environmental materials, such as water, soil, rocks, and plant as well as in animals and human body tissues. Therefore, human being and environment are at constant radiation exposure. Regarding this, the present study aimed to determine the specific activities of radionuclides and perform the risk assessment wheat and barley samples in Karbala, Iraq. Materials and Methods: In this study, natural and artificial radioactivity concentrations were determined in wheat and barley samples, as well as their surrounding soil, using gamma ray spectrometrymethod by means of a high-purity germanium (HPGe) detector with 88% relative efficiency. According to the measured specific activities of radionuclides in food samples and according to annual consumption of wheat and barley by adult person excess lifetime cancer risk due to ingestion of radionuclides was calculated. Results: Specific activities of 226Ra, 232Th, 40K, and 137Cs in the soil samples varied within the ranges of 29.37-38.86, 23.24-45.70, 291.15-549.78, and 1.25-10.82Bq/kg, respectively. The excess lifetime cancer risk due to the ingestion of wheat and barley were calculated as 0.013×10-3 and 0.006×10-3, respectively, which are lower than the maximum acceptable value (10-3). Conclusion: As the findings of the present study indicated, the specific activities of natural radionuclides in the soil were close to that of the world average. The observation of artificial radiocaesium, which is released by nuclear accidents or weapon test, in all soil samples was indicative of the pollution of the studied regions by radioactive dust.

High Frequency of Extractable Nuclear Autoantibodies in Wheat-Related Disorders.

Background and aims:There has been broad interest to explore the presence of autoimmunity among wheat-sensitive individuals, but neither the pathogenesis nor the relevance has been established. In this study, we evaluated the frequencies and levels of autoantibodies, which are important biomarkers of autoimmunity, in subjects with wheat-related disorders and controls. Anti-nuclear antibodies (ANA) and the specific ones against extractable nuclear antigens (ENA) were investigated.Methods:A total of 713 subjects who showed symptoms related to wheat ingestion were addressed to Vibrant America Clinical Laboratory from December 2015 to November 2017. Serum samples were collected from all subjects and tested with a wheat protein antibody panel (IgG and IgA to 18 proteins at the peptide level) and an autoantibody panel (ANA by immunofluorescence analysis and 10 ENA antibodies). Retrospective analysis was completed using de-identified clinical data and test results.Results:In the retrospective analysis, 38 (5%) were seropositive in a Celiac Disease panel, 491 (83%) were seropositive in a wheat protein antibody panel “Wheat Zoomer,” and 84 (12%) were seronegative in both panels. Anti-nuclear antibodies were detected in similar portions of the celiac disease subjects (13%), the Wheat Zoomer–positive subjects (12%), and seronegative controls (15%), which is also very close to the reported occurrence of ANA positivity (15%) in the healthy population. The prevalence of anti-ENA was reported to be less than 2% in the general population; however, our study found it to be much higher in the celiac disease subjects (29%) and the wheat-sensitive subjects (27%), compared with a smaller proportion of seronegative controls (19%). The prevalence of anti-histone was especially prominent among the celiac disease subjects (73%) and the Wheat Zoomer–positive subjects (60%).Conclusions:High proportions of wheat-related disease subjects carry ENA antibodies that are important specific biomarkers of autoimmunity.

The Overlapping Area of Non-Celiac Gluten Sensitivity (NCGS) and Wheat-Sensitive Irritable Bowel Syndrome (IBS): An Update.

Gluten-related disorders have recently been reclassified with an emerging scientific literature supporting the concept of non-celiac gluten sensitivity (NCGS). New research has specifically addressed prevalence, immune mechanisms, the recognition of non-immunoglobulin E (non-IgE) wheat allergy and overlap of NCGS with irritable bowel syndrome (IBS)-type symptoms. This review article will provide clinicians with an update that directly impacts on the management of a subgroup of their IBS patients whose symptoms are triggered by wheat ingestion.

Tritordeum: a novel cereal for food processing with good acceptability and significant reduction in gluten immunogenic peptides in comparison with wheat.

Tritordeum is a novel cereal obtained from the hybridization between durum wheat and a wild barley. This study evaluates acceptance, digestibility and immunotoxic properties of tritordeum, a novel cereal for food processing. Nineteen healthy volunteers participated in a study with different diets to compare tritordeum bread with wheat and gluten-free breads. Tritordeum breads had a similar acceptance to the wheat bread usually consumed, and the acceptance was significantly higher than the gluten-free bread and standardized wheat bread supplied in the study. There was no evidence for gastrointestinal symptoms among volunteers during the study. The reductions in the numbers of immunogenic epitopes in tritordeum in comparison with wheat were 78% for α-gliadins, 57% for γ-gliadins and 93% for ω-gliadins. The analysis of gluten immunogenic peptides (GIP) in stool samples showed a significantly lower excretion in the tritordeum ingestion phase than in the wheat ingestion phase. These results suggest that tritordeum may be an option of interest for general food processing, and especially for those who want to reduce their intake of gluten. However, it is not suitable for celiac disease sufferers as it contains gluten. © 2017 Society of Chemical Industry.

Non-coeliac gluten sensitivity.

Irritable bowel syndrome-like symptoms in response to wheat ingestion is common and well described, but whether the reaction is due to gluten (i.e., non-coeliac gluten sensitivity), other wheat proteins, or FODMAPs (mostly fructans) alone or in combinations has not been clearly defined. Exclusion of coeliac disease in the presence of negative serology, and normal villous architecture but increased density of intraepithelial lymphocytes on duodenal biopsies, is difficult. Furthermore, the confidence by which a positive diagnosis is made or non-coeliac gluten sensitivity is excluded by blinded placebo-controlled rechallenge with wheat protein is reduced by strong nocebo responses generally found in patients with self-reported non-coeliac gluten sensitivity. The absence of a clear biological mechanism of action and difficulties with the design and interpretation of research studies have plunged this entity into even deeper controversy. In the absence of clarity in its diagnosis, the epidemiology, prognosis, and therapeutic approaches to a patient who may be gluten sensitive remain to be determined. Adequate understanding of the issues surrounding the controversy and further research will slowly unravel the truth behind the problem.