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Nutr Rev. 2018 Feb 1;76(2):79-87. doi: 10.1093/nutrit/nux068.

The 5 Ws of a gluten challenge for gluten-related disorders.

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Department of Nutrition, School of Medicine, University of Chile, Santiago, Chile.
Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy.
Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy.
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
Institute of Nutrition and Food Technology, INTA, University of Chile, Santiago, Chile.


Gluten-related disorders (GRDs) are gradually emerging as epidemiologically relevant diseases, with a global prevalence estimated to be approximately 5% in the population. Conditions related to gluten ingestion include celiac disease (CD), wheat allergy (WA), and nonceliac gluten sensitivity (NCGS). Although mediated by different pathogenic pathways, these 3 conditions share similar clinical manifestations and can present a difficult differential diagnosis. The gluten challenge (GC) is an important diagnostic tool for GRDs, but there is great variability in regards to deciding which patients should be challenged, what amount of gluten should be used, what the GC duration should be, when and where the GC should occur, and, sometimes, why to conduct a GC. This review summarizes the current knowledge about the desirable characteristics of GCs in the 3 main GRDs following a 5 Ws approach-that is, the 5 main journalistic questions: who, what, when, where, why. The answers will help to determine the correct use of the GC in diagnosing GRDs.


celiac disease; gluten challenge; gluten-related disorders; nonceliac gluten sensitivity; wheat allergy

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