Gluten intolerance and autoimmunity

Celiac disease (CD) is a systemic chronic autoimmune-mediated disorder elicited by gluten and related prolamines in genetically predisposed individuals. It is part of a wider spectrum of gluten-related disorders. A significantly increased prevalence of other autoimmune diseases (ADs), especially thyroiditis and type 1 diabetes, has been reported in CD patients and their first-degree relatives, with an estimated burden of AD in CD cases up to 15%. This association has typically been attributed to a common genetic background including both human leukocyte antigen (HLA) and non-HLA genes, but also common environmental triggers such as early viral infections, changes in the gut microbiota, and alterations of the intestinal barrier can play a role. Pathogenic mechanisms are also shared. Beyond antitransglutaminase antibodies whose pathogenic role remains to be elucidated, other autoantibodies are present. From the clinical point of view, associated diseases ask for screening policies. While gluten-free diet is curative for CD, its effect on other concomitant AD is still unclear.