The immunology of gluten sensitivity: beyond the gut

The terms gluten sensitivity and coeliac disease (also known as gluten-sensitive enteropathy) have thus far been used synonymously to refer to a disease process affecting the small bowel and characterised by malabsorption and gastrointestinal symptoms. Yet, gluten sensitivity can exist even in the absence of an enteropathy. The systemic nature of this disease, the overwhelming evidence of an immune pathogenesis and the accumulating evidence of diverse manifestations involving organs other than the gut, such as the skin (dermatitis herpetiformis) and the nervous system (gluten ataxia, gluten neuropathy), necessitates a re-evaluation of the belief that gluten sensitivity is solely a disease of the gut. By studying the pathogenesis of these diverse manifestations we are more likely to improve our understanding of this disease entity as a whole.