Table 1.
Main characteristics of the three different gluten-related diseases: Celiac disease (CD), non-Celiac gluten sensitivity (NCGS), and wheat allergy (WA).
| Celiac Disease (CD) | Non Celiac Gluten Sensitivity (NCGS) | Wheat Allergy (WA) | |
|---|---|---|---|
| Prevalence | 1% of the general population | Unknown | 0.5–9% of the general population (>in children) |
| HLA-DQ2/8 haplotypes | Positive | Positive in 50% of the patients | Negative |
| Pathogenesis | Autoimmune | Activation of the innate and adaptive immune response | IgE-mediated |
|
Serological markers
Duodenal biopsy |
Positive IgA-TG2, IgA-EMA and IgA/IgG-DGP antibodies Necessary * |
IgA/IgG anti-gliadin positive in 50% of the patients Necessary to rule out CD |
Wheat specific IgE antibodies or prick test Not necessary |
| Therapy | Strict gluten free diet | Gluten-free diet | Avoid all contact with wheat |
* In the latest ESPGHAN guidelines, duodenal biopsy is not necessary in pediatric patients who have positive anti-TG2 antibodies (>10 times) and positive anti-EMA antibodies in a second sample. (ESPGHAN) [18].