Spectrum of gluten-related disorders: consensus on new nomenclature and classification

doi:10.1186/1741-7015-10-13

BMC Med. 2012; 10: 13.

Published online 2012 February 7. doi: 10.1186/1741-7015-10-13

PMCID: PMC3292448

Spectrum of gluten-related disorders: consensus on new nomenclature and classification

Anna Sapone,^1,² Julio C Bai,³ Carolina Ciacci,⁴ Jernej Dolinsek,⁵ Peter HR Green,⁶ Marios Hadjivassiliou,⁷ Katri Kaukinen,⁸ Kamran Rostami,⁹ David S Sanders,¹⁰ Michael Schumann,¹¹ Reiner Ullrich,¹¹ Danilo Villalta,¹² Umberto Volta,¹³ Carlo Catassi,^1,¹⁴ and Alessio Fasano¹

¹Mucosal Biology Research Center and Center for Celiac Research, University of Maryland School of Medicine, Baltimore, MD 21201, USA

²Department of Internal and Experimental Medicine Magrassi-Lanzara, Second University of Naples, Naples, Italy

³Department of Medicine, Dr Carlos Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina

⁴Gastroenterology Unit, University of Salerno School of Medicine, Salerno, Italy

⁵University Medical Centre Maribor, Ljubljansk, Slovenia

⁶Celiac Disease Center, Columbia University, New York, NY 10032, USA

⁷Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK

⁸Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Finland

⁹Dudley Group of Hospitals, University of Birmingham Medical School, Birmingham, UK

¹⁰Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital and University of Sheffield Medical School, Sheffield, UK

¹¹Department of Gastroenterology, Rheumatology and Infectivology, Charité University Medicine, Berlin, Germany

¹²Allergy and Clinical Immunology Unit, DML, AO Santa Maria degli Angeli, Pordenone, Italy

¹³Department of Digestive Diseases and Internal Medicine, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

¹⁴Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy

Corresponding author.

Anna Sapone: annasapone/at/yahoo.it; Julio C Bai: jbai/at/intramed.net; Carolina Ciacci: ciacci/at/unina.it; Jernej Dolinsek: jernej.dolinsek/at/ukc-mb.si; Peter HR Green: pg11/at/columbia.edu; Marios Hadjivassiliou: m.hadjivassiliou/at/sheffield.ac.uk; Katri Kaukinen: katri.kaukinen/at/uta.fi; Kamran Rostami: krostami/at/hotmail.com; David S Sanders: David.Sanders/at/sth.nhs.uk; Michael Schumann: michael.schumann/at/charite.de; Reiner Ullrich: reiner.ullrich/at/charite.de; Danilo Villalta: danilo.villalta/at/aopn.fvg.it; Umberto Volta: umberto.volta/at/aosp.bo.it; Carlo Catassi: catassi/at/tin.it; Alessio Fasano: afasano/at/mbrc.umaryland.edu

Received October 9, 2011; Accepted February 7, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract

A decade ago celiac disease was considered extremely rare outside Europe and, therefore, was almost completely ignored by health care professionals. In only 10 years, key milestones have moved celiac disease from obscurity into the popular spotlight worldwide. Now we are observing another interesting phenomenon that is generating great confusion among health care professionals. The number of individuals embracing a gluten-free diet (GFD) appears much higher than the projected number of celiac disease patients, fueling a global market of gluten-free products approaching $2.5 billion (US) in global sales in 2010. This trend is supported by the notion that, along with celiac disease, other conditions related to the ingestion of gluten have emerged as health care concerns. This review will summarize our current knowledge about the three main forms of gluten reactions: allergic (wheat allergy), autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia) and possibly immune-mediated (gluten sensitivity), and also outline pathogenic, clinical and epidemiological differences and propose new nomenclature and classifications.

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