The neuroimmunology of gluten intolerance

Abstract

The term gluten-related disorders (GRD) denotes a spectrum of diverse immune-mediated diseases triggered by the ingestion of gluten (protein found in wheat, barley and rye). Coeliac disease (CD) or gluten-sensitive enteropathy is the most recognised and studied entity within GRD. Extraintestinal manifestations are gaining recognition and are increasingly the subject of further studies as they may hold the key to unravelling the pathophysiology of GRD. Such manifestations include skin involvement in the form of dermatitis herpetiformis (DH) and neurological dysfunction (e.g. gluten ataxia and gluten neuropathy). Furthermore, the recent concept of extraintestinal manifestations without enteropathy (termed non- coeliac gluten sensitivity (NCGS)) has become accepted as part of the same spectrum. In this chapter, we review the neurological manifestations in GRD and discuss recent advances in diagnosis and possible pathophysiological mechanisms.