Initially designed as treatment for celiac disease, the gluten-free diet is proving to have more applications than originally thought. In fact, researchers are finding that there is a spectrum of gluten-related disorders; the challenge now is how to classify them.

A group of 15 renowned celiac disease researchers have published a report that includes guidance on classifying gluten-related disorders and an algorithm outlining the steps for proper diagnosis of each disorder.

The report breaks the spectrum down into three main categories, based on pathogenesis:

• Allergic – Including wheat allergy, which was further broken down into baker’s asthma and rhinitis; food allergy affecting the respiratory, skin or gastroenterology tract; wheat-dependent, exercise-induced anaphylaxis and contact urticaria. The onset of symptoms is minutes to hours after gluten exposure.
• Autoimmune – Including celiac disease, dermatitis herpetiformis (DH) and gluten ataxia. The onset of symptoms is weeks to years after gluten exposure.
• Immune-mediated (Not autoimmune, not allergic) – Including gluten sensitivity (GS). The onset of symptoms is hours to days after gluten exposure.

The article noted that while there are recommended tests for wheat allergy and celiac disease, there are no recommended tests for gluten sensitivity. GS is diagnosed through exclusion criteria by first testing for wheat allergy and celiac disease, and if tests are negative, is then followed up with an elimination diet and a “monitored reintroduction of gluten-containing foods.”

The researchers noted that very little is known about gluten-related disorders other than celiac disease, notably gluten sensitivity, and called for more research on the topic:

“Further studies are urgently required to clarify whether the spectrum of toxic cereals, the gluten threshold and the disease duration are the same in gluten allergy and/or sensitivity as in CD,”they wrote.

In addition to the disorders listed above, the researchers also touched upon other conditions that may benefit from a gluten-free diet, including schizophrenia, multiple sclerosis, autism spectrum disorders and dementia. Again, they called for more research due to the potential “placebo effect,” which could occur in GS as well, when instituting a gluten-free diet.

Finally, the researchers raised the important issue of distinguishing between those who need the gluten-free diet (GFD) for medical reasons and those who do not:

“‘Allergy’ is currently all the rage, and it is well possible that many individuals are on a GFD for no sound medical reasons. In these cases, the diagnostic algorithm described in this paper will help to select patients who really need treatment with a GFD,”the reseachers wrote.

Read the full article: Spectrum of gluten-related disorders: consensus on new nomenclature and classification