Abstract
BACKGROUND: A hypersensitivity reaction has been hypothesized as one of the possible pathophysiological mechanisms involved in non-celiac wheat sensitivity (NCWS). Some studies have reported a high frequency of atopic diseases in NCWS patients. OBJECTIVES: This study aimed (A) to define the presence and features of atopic diseases and other hypersensitivities in NCWS patients and (B) to search for possible allergic features which could address a NCWS diagnosis. METHODS: Clinical, laboratory and histological data from NCWS patients before the start of a wheat-free diet were retrospectively analyzed and compared to control subjects with celiac disease (CeD) or irritable bowel syndrome/functional dyspepsia (IBS/FD). RESULTS: Atopic disease prevalence was higher in the NCWS patients (32.8%) than in those with CeD (19.3%) and IBS/FD (21.5%) (p = 0.001 for both). Similarly, NCWS subjects reported a higher frequency of multiple food sensitivities (MFSs) (39.8%) and self-reported milk intolerance (SRMI) (65.9%) compared to the control groups (p < 0.001 for both). On multiple logistic regression analysis, a coexistent atopic disease (OR 1.481), MFS (OR 3.882) and SRMI (OR 2.259) proved to be variables associated with the NCWS diagnosis. CONCLUSIONS: NCWS subjects have a higher frequency of atopic disease, MFS and SRMI when compared to both CeD and IBS/FD patients. All these conditions could be considered as an expression of an underlying hypersensitivity milieu characterizing NCWS and might be of support in the differential diagnosis between NCWS and functional gastrointestinal disorders, if inserted into a broader diagnostic panel.