Reactivity to dietary gluten: new insights into differential diagnosis among gluten-related gastrointestinal disorders

The ingestion of dietary gluten sometimes may trigger allergic, autoimmune or nonallergic and nonautoimmune response. The typical gluten-related allergic disorder is the wheat allergy (WA). Celiac disease (CD) is a well-known gluten-related autoimmune condition. The clinical expression of a gluten-related nonallergic and nonautoimmune response is nonceliac gluten sensitivity (NCGS), an emerging condition whose framework is yet unclear and whose diagnosis is suggested only by demonstration of gluten-dependency in patient' symptoms after exclusion of WA and CD. This review discusses the current tools to identify patients suffering from WA, CD, and NCGS, as well as the most recent insights in the differential diagnosis among these gluten-related gastrointestinal disorders.