Identifying True Celiac Disease and Wheat Allergy in the Era of Fashion Driven Gluten-Free Diets

Int Arch Allergy Immunol. 2019;179(2):132-141. doi: 10.1159/000497115. Epub 2019 Mar 21.

Abstract

Background: Diagnosing both celiac disease (CD) and wheat allergy (WA) might be challenging due to the increasingly popular gluten-free diets.

Objectives: This study investigates the value of anti-tissue transglutaminase IgA (tTGIgA) and wheat-specific IgE (WIgE), and identifies clinical and serological features associated with CD and WA.

Method: Serological markers of autoimmunity and allergy along with medical charts of patients assessed for tTGIgA and WIgE between 2010 and 2016 were evaluated.

Results: During the last years, an increasing number of patients have been tested for tTGIgA, while the number of positive results decreased linearly. Among the 2,965 patients included, 128 patients showed at least once a positive tTGIgA. All patients with tTGIgA levels higher than the 12-fold upper normal limit had CD. The ratio of tTGIgA/total IgA did not perform better as a diagnostic test for CD compared to tTGIgA. tTGIgA and anti-nuclear antibodies were significantly associated. WA was only rarely investigated, particularly in adults. However, positive WIgE were found in nearly 50% of the cases. WIgE and tTGIgA values were negatively correlated.

Conclusions: tTGIgA were increasingly tested, while the rate of positive results decreased in recent years, possibly reflecting the impact of current alimentary trends on clinical practice. Associated autoimmune disease was frequently found in CD. High levels of tTGIgA accurately predicted CD diagnosis. WA was rarely investigated and deserves more attention, in particular in children with atopic background. WA does not seem to be associated with CD.

Keywords: Celiac disease; Specific IgE; Wheat allergy.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibody Specificity / immunology
  • Biomarkers
  • Biopsy
  • Celiac Disease / diagnosis*
  • Celiac Disease / prevention & control
  • Child
  • Child, Preschool
  • Comorbidity
  • Diagnosis, Differential
  • Diet, Gluten-Free
  • Female
  • GTP-Binding Proteins / immunology
  • Glutens / adverse effects
  • Glutens / immunology
  • Humans
  • Immunoglobulin A / immunology
  • Immunoglobulin E / immunology
  • Infant
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Protein Glutamine gamma Glutamyltransferase 2
  • ROC Curve
  • Transglutaminases / immunology
  • Wheat Hypersensitivity / diagnosis*
  • Wheat Hypersensitivity / prevention & control
  • Young Adult

Substances

  • Biomarkers
  • Immunoglobulin A
  • Immunoglobulin E
  • Glutens
  • Protein Glutamine gamma Glutamyltransferase 2
  • Transglutaminases
  • GTP-Binding Proteins