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Spectrum of gluten-related disorders: consensus on new nomenclature and classification

Anna Sapone12, Julio C Bai3, Carolina Ciacci4, Jernej Dolinsek5, Peter HR Green6, Marios Hadjivassiliou7, Katri Kaukinen8, Kamran Rostami9, David S Sanders10, Michael Schumann11, Reiner Ullrich11, Danilo Villalta12, Umberto Volta13, Carlo Catassi114 and Alessio Fasano1*

Author Affiliations

1 Mucosal Biology Research Center and Center for Celiac Research, University of Maryland School of Medicine, Baltimore, MD 21201, USA

2 Department of Internal and Experimental Medicine Magrassi-Lanzara, Second University of Naples, Naples, Italy

3 Department of Medicine, Dr Carlos Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina

4 Gastroenterology Unit, University of Salerno School of Medicine, Salerno, Italy

5 University Medical Centre Maribor, Ljubljansk, Slovenia

6 Celiac Disease Center, Columbia University, New York, NY 10032, USA

7 Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK

8 Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Finland

9 Dudley Group of Hospitals, University of Birmingham Medical School, Birmingham, UK

10 Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital and University of Sheffield Medical School, Sheffield, UK

11 Department of Gastroenterology, Rheumatology and Infectivology, Charité University Medicine, Berlin, Germany

12 Allergy and Clinical Immunology Unit, DML, AO Santa Maria degli Angeli, Pordenone, Italy

13 Department of Digestive Diseases and Internal Medicine, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

14 Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy

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BMC Medicine 2012, 10:13  doi:10.1186/1741-7015-10-13

Published: 7 February 2012


A decade ago celiac disease was considered extremely rare outside Europe and, therefore, was almost completely ignored by health care professionals. In only 10 years, key milestones have moved celiac disease from obscurity into the popular spotlight worldwide. Now we are observing another interesting phenomenon that is generating great confusion among health care professionals. The number of individuals embracing a gluten-free diet (GFD) appears much higher than the projected number of celiac disease patients, fueling a global market of gluten-free products approaching $2.5 billion (US) in global sales in 2010. This trend is supported by the notion that, along with celiac disease, other conditions related to the ingestion of gluten have emerged as health care concerns. This review will summarize our current knowledge about the three main forms of gluten reactions: allergic (wheat allergy), autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia) and possibly immune-mediated (gluten sensitivity), and also outline pathogenic, clinical and epidemiological differences and propose new nomenclature and classifications.