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Allergo J Int. 2018;27(5):147-151. doi: 10.1007/s40629-018-0070-2. Epub 2018 May 28.

Non-celiac gluten/wheat sensitivity (NCGS)-a currently undefined disorder without validated diagnostic criteria and of unknown prevalence: Position statement of the task force on food allergy of the German Society of Allergology and Clinical Immunology (DGAKI).

Author information

1
Dietary Counseling and Nutrition Therapy with Specialization in Allergology, Ansprenger Str. 19, 80803 Munich, Germany.
2
Outpatient Center of Allergy and Pulmonology (Schwerpunktpraxis Collonaden), Dietary Counseling and Nutrition Therapy, Hamburg, Germany.
3
Outpatient & Clinical Research Center, Allergy and Asthma Center Westend, Berlin, Germany.
4
4Division of Allergology, Paul Ehrlich Institute (Federal Institute for Vaccines and Biomedicines), Langen, Germany.
5
5Department of Pediatrics, Division of Pulmonology, Immunology and Intensive Care Medicine, Charité University Hospital, Berlin, Germany.
6
6Department of Gastroenterology, Hepatology and Endocrinology, Hanover Medical School, Hanover, Germany.
7
7Allergy Unit, Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
8
8Institute of Clinical Nutrition, University of Hohenheim, Stuttgart, Germany.
9
9Department of Pediatrics, Division of Allergy, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Frankfurt am Main, Germany.
10
10Department of Dermatology, Venereology and Allergology, Allergy Center Charité (ACC), Charité University Hospital, Berlin, Germany.
11
11Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
12
12Derpartment of General and Special Pediatrics, Olga Hospital (Klinikum Stuttgart), Stuttgart, Germany.
13
Pediatric Allergology and Pulmonology, Department of Pediatrics and Adolescent Medicine, Salzburg State Clinics, Paracelsus Medical Private University, Salzburg, Austria.
14
Patient Support Group: Deutscher Allergie- und Asthmabund, DAAB, German Allergy and Asthma Association, Mönchengladbach, Germany.
15
Department of Pediatrics, St. Marien Hospital, Bonn, Germany.
16
Respiratory Medicine and Allergology Outpatient Center Dr. Lepp, Buxtehude, Germany.
17
17Department of Dermatology, Faculty of Medicine, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.
18
Department of Internal Medicine and Institute of Neurogastroenterology, Martin-Luther Hospital, Berlin, Germany.
19
19Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany.
20
20Institute for Medical Education, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
21
21Pediatric Pulmonology, Allergy and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
22
22Department of Dermatology, Venereology and Allergology, Interdisciplinary Center of Allergology, University Medical Center Leipzig, Leipzig, Germany.
23
Dermatology Outpatient Center Hamburg-Alstertal, Hamburg, Germany.
24
24Department of Dermatology, Allergology and Venereology, Department of Immunodermatology and Experimental Allergology, Hanover Medical School (MHH), Hanover, Germany.

Abstract

Within the last decade, non-celiac gluten/wheat sensitivity (NCGS) has been increasingly discussed not only in the media but also among medical specialties. The existence and the possible triggers of NCGS are controversial. Three international expert meetings which proposed recommendations for NCGS were not independently organized and only partially transparent regarding potential conflicts of interest of the participants. The present position statement reflects the following aspects about NCGS from an allergist's and nutritionist's point of view: (A) Validated diagnostic criteria and/or reliable biomarkers are still required. Currently, this condition is frequently self-diagnosed, of unknown prevalence and non-validated etiology. (B) Gluten has not been reliably identified as an elicitor of NCGS because of high nocebo and placebo effects. Double-blind, placebo-controlled provocation tests are of limited value for the diagnosis of NCGS and should be performed in a modified manner (changed relation of placebo and active substance). (C) Several confounders hamper the assessment of subjective symptoms during gluten-reduced or gluten-free diets. Depending on the selection of food items, e.g., an increased vegetable intake with soluble fibers, diets may induce physiological digestive effects and can modify gastrointestinal transit times independent from the avoidance of gluten. (D) A gluten-free diet is mandatory in celiac disease based on scientific evidence. However, a medically unjustified avoidance of gluten may bear potential disadvantages and risks. (E) Due to a lack of diagnostic criteria, a thorough differential diagnostic work-up is recommended when NCGS is suspected. This includes a careful patient history together with a food-intake and symptom diary, if necessary an allergy diagnostic workup and a reliable exclusion of celiac disease. We recommend such a structured procedure since a medically proven diagnosis is required before considering the avoidance of gluten.

KEYWORDS:

Gluten-free; Irritable bowel syndrome; Nocebo effects; Placebo effects; Self-diagnosis

Conflict of interest statement

The authors declare that they have no competing interests.

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