The immunology of gluten sensitivity beyond the intestinal tract

Gluten sensitivity, celiac disease (CD) and gluten-sensitive enteropathy are terms that have been used synonymously to refer to a disease process affecting the small bowel and characterized by gastrointestinal symptoms and malabsorption. However, since 1966 scientific evidence has been accumulated demonstrating that gluten sensitivity can exist even in the absence of enteropathy. For example, patients with dermatitis herpetiformis and presentation of blistering skin do not have any gastrointestinal symptoms but have elevated gliadin antibody in the blood which improves on a gluten-free diet (1). Additionally, associations of CD with the involvement of other organs such as the central and peripheral nervous systems also go as far back as 1966 (2). However, until recently, this phenomenon of immune reaction against neural tissue, in particular the cerebellum, was attributed to vitamin deficiencies. During the past five years, based on overwhelming evidence of immune pathogenesis involving organs other than gut and skin, many scientists have begun to re-evaluate Vol. 6, no. 2, 0-0 (2008)