New insights and evidence on “Food Intolerances”: non-celiac gluten sensitivity and nickel allergic contact mucositis

The clinical examination of patients often comes across the observation of the existence of a close relationship between the ingestion of certain foods and the appearance of various symptoms. Until now, the occurrence of these events has been loosely defined as food intolerance. Today these conditions should more properly be called Adverse Food Reactions (AFRs) which can consist of the presentation of a wide variety of symptoms which are commonly identified as Irritable Bowel Disease (IBS) syndrome. In addition, systemic manifestations such as neurological, dermatological, joint and respiratory disorders may also occur in affected patients. Although the etiology and pathogenesis of some of them are already known, others, such as non-celiac gluten sensitivity and adverse reactions to nickel-containing foods, are not yet fully defined. The study was aimed at evaluating the relationship between the ingestion of some foods and the appearance of some symptoms, clinical improvement and detectable immunohistochemical alterations after a specific exclusion diet. One hundred and six consecutive patients suffering from meteorism, dyspepsia and nausea following the ingestion of foods containing gluten or nickel were subjected to the GSRS questionnaire, modified according to the "Salerno expert criteria". All patients underwent detection of IgA antibodies to tissue transglutaminase, oral mucosal patch test with gluten and nickel (OMPT), and EGDS including biopsies. Our data show that GSRS and OMPT, the use of APERIO CS2 software and the endothelial marker CD34 could be suggested as useful tools in the diagnostic procedure of these new pathologies. Larger, multi-center clinical trials could be helpful in defining these emerging clinical problems.