#Ufocus guidance for the puzzled skin

Non-coeliac gluten sensitivity (NCGS) is a condition where intestinal and extra-intestinal symptoms are triggered by gluten ingestion in the absence of coeliac disease and wheat allergy, as defined by discussions held at three different international consensus conferences. 5 IBS presents a major challenge for clinicians, because of multiple contributing factors and conflicting evidence for management strategies and suitable pharmaceutical therapies. Irritable bowel syndrome (IBS) is a disorder characterised by GI symptoms (abdominal pain, diarrhea), with no abnormal pathology and affects 15% of the population. The GI manifestations of wheat allergy may be similar to those of coeliac disease but instead does not cause permanent GI damage.

#Ufocus guidance for the puzzled skin

The symptoms of wheat allergy develop within minutes to hours after gluten ingestion and include itching and swelling in the mouth, nose, eyes and throat, skin rash and wheezing, and life-threatening anaphylaxis. Wheat allergy is an IgE mediated reaction to the insoluble gliadins of wheat. In addition, non-specific signs and symptoms (iron deficiency anaemia, osteoporosis, fatigue) or even asymptomatic presentation are now accepted to be common. Many of the classical clinical symptoms seen in coeliac disease picture malabsorption (diarrhoea, abdominal pain, bloating, wind, distension). After digestion, gluten peptides are deaminated by the tissue-transglutaminase and presented to activated T cells, which then produce interferon-γ and other cytokines, leading to mucosal damage of the small bowel. 2 The only known treatment is a lifelong, strict gluten-free diet (GFD).

2 More than 95% of patients with coeliac disease carry the HLA-DQ2 or HLA-DQ8 heterodimers and the rest express HLA-DQ that contain half of the coeliac associated molecules. Coeliac disease affects at least 1% of Western populations and leads to small bowel damage and elevated coeliac-specific antibodies. Coeliac disease occurs when genetically susceptible patients are exposed to dietary gluten, the major protein in wheat, rye, barley and related grains, activating a specific immune response.