Wheat sensitivity without the presence of celiac disease or wheat allergy

Even without the presence of celiac disease or wheat-specific allergy wheat can induce various gastrointestinal and extraintestinal symptoms. Non-celiac wheat sensitivity (NCWS) represents a new clinical entitity within the wide spectrum of wheat intolerances. Epidemiological data are scarce -limited studies suggest that 1-6% of the general population might suffer from NCWS, and about 1/3 of all IBS patients might benefit from a gluten-free diet. Pathogenetically, and contrary to celiac disease and wheat allergy, the NCWS features show neither an underlying allergy nor an autoimmune-moderated reaction but are most likely a toll-like-receptor-mediated reaction of the innate immune system against wheat proteins and amylase-trypsin inhibitors; -FODMAPs might also play a role in a subgroup of IBS and NCWS. This article presents an overview over the current scientific knowledge about NCWS and draws practical conclusions for clinical practice. A GFD and a gluten stress test prove to be helpful diagnostic measures.