Coeliac disease

What is it? Coeliac disease (CD) is a chronic inflammation of the small intestine, triggered in genetically predisposed individuals, by dietary gluten.

Dermatitis Herpetiformis (DH) is chronic inflammatory disease, triggered in genetically predisposed individuals by dietary gluten. It usually shows up with characteristic blistering and itchy skin lesions and pathognomonic intra-dermal IgA deposits. Both disappear upon a gluten-free diet. DH is considered as a dermatological variant of CD, even if intestinal lesion, often mild, are present in a very small percentage of DH affected patients.

Gluten: Gluten is a protein fraction of wheat, rye and barley. Gluten has two fractions: gliadins (the alcohol-soluble one) and glutenins (the acetic -soluble one).

Symptoms: The clinical spectrum of CD is wide and includes symptomatic cases with either classical intestinal (for example, chronic diarrhea, weight loss) or non-classical extra intestinal symptoms and signs. CD sometimes is associated with some autoimmune diseases. Differently from the allergy to wheat proteins, CD and DH are not elicited by the skin contact with gluten, but exclusively by the dietary exposure to gluten. Untreated CD might lead to some complications, some of which are severe such as intestinal
malignancy.

Diagnosis: CD diagnosis is made by means of the determination of anti transglutaminase and anti-endomisium antibodies in the peripheral blood, followed by small intestine biopsy. These tests must be performed during a gluten-containing
diet.

Therapy: At the moment, a long-life, strict gluten-free diet is the only available therapy for CD. Recent studies demonstrated that neither the timing of first introduction of gluten during the weaning, nor the duration of breast-feeding lower the risk of developing celiac disease *among at-risk infants, although the later introduction of gluten is associated with a delayed clinical onset of the disease.