Pasta, bread and pizza are the cornerstones of the Italian diet, but today they are increasingly put aside due to the increase in ‘gluten intolerance’ which in Italy alone affects around 12% of the population. Tomorrow at the A. Gemelli Irccs University Hospital in Rome a conference will bring together gastroenterologists, allergists, nutritionists, agricultural experts and producers to discuss the possible causes of this ‘epidemic’. But when does wheat make you sick and when are we talking about celiac disease, wheat allergy or gluten sensitivity? The Gemelli experts respond.
Celiac disease. “It is a well-known pathology which affects 1% of the Italian population (around 600,000 people, of whom it is estimated that only a third have been correctly diagnosed) and is growing; it occurs in genetically predisposed subjects (carriers of the Hla haplotype DQ2/DQ8, but the genetic test only serves to exclude the diagnosis). “The ingestion of products (wheat, barley, rye, spelt, etc.) containing gliadin (gluten protein) – explains Giovanni Cammarota, director of the Unit complex operation of Gastroenterology at the Fondazione Policlinico Gemelli Irccs – triggers an autoimmune inflammatory response which damages the intestinal mucosa and reduces its absorptive capacity”.
“The diagnosis – continues the specialist – is based on clinical suspicion, on the serological analysis of antibodies (anti-endomysium, anti-transglutaminase class IgA and IgG, anti-deamidated gliadin), which must be done while following a free and not ‘gluten free’, and on histological confirmation with a biopsy of the duodenal villi taken through a gastro-duodenoscopy, which highlights the atrophy of the intestinal villi (in children for the diagnosis it is sufficient to demonstrate the presence of anti-transglutaminase antibodies greater than 10 times the norm). The only treatment for now is a gluten-free diet, which allows the restoration of damaged intestinal tissues.”
Wheat allergy. “Some people – recall the Gemelli experts – may have an allergy to a wheat protein. It is a true allergy, an immediate reaction triggered by IgE. It can manifest itself with urticarial reactions, intense itching, severe abdominal pain. It manifests itself generally in newborns and early childhood and tends to disappear with growth. It is present in over a third of children with atopic dermatitis. In adults it manifests itself as an immediate reaction to wheat gluten allergy or as wheat-dependent anaphylaxis induced by “physical exercise (Wdeia), and in this case it is destined to last over time. The treatment consists of a diet excluding wheat products or a desensitizing therapy to wheat, also using antihistamines, cortisone and biological drugs”.
Gluten sensitivity. “It is a very vast and very insidious chapter (up to 12% of Italians self-diagnose it) and there are no objective diagnostic markers capable of intercepting it”, the specialists highlight. “The patient – describes Cammarota – reports symptoms (abdominal pain, bloating, nausea, headache, feeling of tiredness, bowel disorders) following the ingestion of gluten and self-diagnoses this ‘intolerance’. It is a condition very widespread, but difficult to diagnose”. Therefore “the diagnosis is only clinical and is confused with that of irritable bowel syndrome and functional disorders. It could make use of a rechallenge (i.e. a re-administration) of gluten, which theoretically, however, should be done in a double blind manner (i.e. neither the patient nor the doctor should know that the foods administered contain gluten)”, the Gemelli experts point out.
“It would be important – concludes Cammarota – to have a continuous dialogue with production, to try to vary the type of wheat and gluten and carry out controlled clinical trials to understand whether or not a certain process causes the appearance of symptoms. This wave of ‘ sensitivity’, however, may not be attributable to the genetics of wheat (i.e. it would not be a question of ‘ancient’ grains or ‘modern’ grains), but rather to modern production and processing techniques”.
For the specialist, “it would also be interesting to vary the type of gluten within wheat, to identify the most immunogenic and capable of stimulating sensitivity. In short, there is gluten and gluten, both in terms of quantity and quality “.