Non-Celiac Gluten Sensitivity: How Its Gut Immune Activation and Potential Dietary Management Differ from Celiac Disease

Mol Nutr Food Res. 2018 May;62(9):e1700854. doi: 10.1002/mnfr.201700854. Epub 2018 Apr 20.


Non-celiac gluten sensitivity (NCGS) is a clinical entity triggered by the ingestion of gluten-containing grains leading to intestinal and/or extraintestinal symptoms that resolve once the gluten-containing foodstuff is eliminated from the diet, and it is diagnosed when celiac disease (CD) and wheat allergy (WA) have been ruled out. The limited knowledge about the pathophysiology of NCGS and the lack of validated biomarkers are still major limitations for clinical studies, making it difficult to differentiate NCGS from other gluten-related disorders (GRD). In the absence of clear-cut diagnostic criteria, NCGS is still mainly a diagnosis of exclusion. Several studies suggest that NCGS is an immune-mediated disease that likely activates an innate immune response. Moreover, it has recently been hypothesized that in addition to gluten, other components of wheat may be responsible for the symptoms observed in individuals without CD. This review aims at discussing available evidence related to the histological and immunological features in the gut mucosa of patients with NCGS and at outlining new dietary opportunities for these patients.

Keywords: adaptive immune response; ancient wheat; gut; innate immune response; non-celiac gluten sensitivity.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Adaptive Immunity*
  • Animals
  • Celiac Disease / diagnosis
  • Celiac Disease / diet therapy
  • Celiac Disease / immunology
  • Celiac Disease / metabolism
  • Diagnosis, Differential
  • Diet, Gluten-Free*
  • Edible Grain / adverse effects
  • Glutens / adverse effects*
  • Humans
  • Immunity, Innate*
  • Intestinal Mucosa / immunology*
  • Intestinal Mucosa / metabolism
  • Malabsorption Syndromes / diagnosis
  • Malabsorption Syndromes / diet therapy*
  • Malabsorption Syndromes / immunology
  • Malabsorption Syndromes / metabolism
  • Models, Immunological*
  • Myeloid Cells / immunology
  • Myeloid Cells / metabolism
  • Triticum / adverse effects
  • Wheat Hypersensitivity / diagnosis
  • Wheat Hypersensitivity / diet therapy
  • Wheat Hypersensitivity / immunology
  • Wheat Hypersensitivity / metabolism


  • Glutens