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p. 12-15 / INTOLERANCES
Coeliac disease: an overview
CHRISTINA R SADLER*, STEFAN STORCKSDIECK GENANNT BONSMANN, MARY FRIEL
*Corresponding author
European Food Information Council (EUFIC), Tassel House, rue Paul-Emile Janson 6, B-1000 Brussels, Belgium

KEYWORDS: coeliac; autoimmune; gluten; labelling; prevalence; diagnosis
ABSTRACT: Coeliac disease is an autoimmune disorder which can develop at any time throughout life. In susceptible individuals, eating gluten, a protein in wheat and related grains, causes damage to the small intestine. Currently, testing for coeliac disease is recommended for individuals at high-risk or presenting symptoms; however it is underdiagnosed due to the diverse clinical presentation. Following a gluten-free diet is currently the only effective treatment. The prescribed gluten-free diet should be monitored, with dietary assessment and support from a trained dietitian. Food labelling helps people with coeliac disease identify ‘gluten free’ or ‘very low gluten’ foods. Research is exploring alternative treatments, and whether the timing and amount of gluten consumed during infancy can be altered for the prevention of coeliac disease.

COELIAC DISEASE AND OTHER ADVERSE REACTIONS TO FOOD
For a small percentage of people, specific foods or components of food may cause non-toxic adverse reactions, typically classified as food allergy (immune-mediated) or food intolerance (non immune-mediated) (1).
A food allergy occurs when an allergen (usually a protein in the offending food, which in the majority of people will not produce an adverse reaction) sets off a chain of reproducible reactions involving the immune system. Allergic reactions can be classified based on the mechanisms involved, i.e. they can be either IgE (immunoglobulin E antibodies) or non-IgE mediated reactions. The former are usually immediate; whereas, the latter are usually more delayed (1).
Food intolerances do not involve the immune system. Food intolerant reactions may be categorised as enzymatic (due to an enzyme deficiency such as lactase which is needed to digest lactose in milk), pharmacological (due to vasoactive amines, e.g. histamine, which may produce pharmacological effects in intolerant patients) or undefined (intolerance resulting from non-identified mechanisms). Some food aversions may mimic allergy or food intolerance, but in fact may be caused by psychological factors (1).
Regarding gluten-related disorders, a group of experts convened in 2011 and discussed current evidence to agree and propose new nomenclature and classification (2). This nomenclature is presented in Figure 1 and is discussed below.
Wheat allergy is an example of an IgE -mediated reaction. It can occur minutes to hours after wheat consumption, and may affect the skin, gastrointestinal tract or respiratory tract (2).
Coeliac disease is neither an allergy nor a simple food intolerance but rather an autoimmune disease. Today’s accepted definition is an ‘immune mediated systemic disorder elicited by gluten and related prolamines in genetically susceptible individuals’ (3). Gluten is found in wheat, rye, barley, oats or their crossbred varieties and derivatives thereof. The specific proteins are gliadins in wheat, secalins in rye, hordeins in barley, and a similar protein, avenin, is found in oats. When people with coeliac disease eat gluten, the body produces antibodies which attack the lining of the small intestine and other areas of the body (4). The onset of symptoms is usually gradual and can arise months or years after gluten introduction. Ingestion...In order to continue reading this article please register to our website – registration is for free and no fees will be applied afterwards to download contents.

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