Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity

Table 1 Diagnostic tests for gluten related disorders

	Serology	Genetic	Histology	Skin tests	Challenges
Celiac disease	Anti transglutaminase IgA plus IgA dosage are used as screening test Anti endomysium as confirmatory test	HLA typing is useful to exclude celiac disease	Presence of duodenal atrophy is considered the gold standard in adulthood	Not used	Gluten challenge is used in case of genetically predisposed patients following a gluten free diet
Wheat allergy	The research of IgE against the suspected allergens is sensitive	Not used	Not strictly indicated	Skin reactions against allergens have a low sensitivity especially in case of wheat due to the absence of specific components in commercial reagents	Challenges with the suspected allergens are still considered the gold standard although potentially dangerous for the patient
Non celiac gluten sensitivity	Anti gliadin IgG positive in 50% of cases	Not used	Not strictly indicated; a mild duodenal intraepithelial lymphocytosis is possible in up to 50% of suspected cases	Not used	Double blind challenge with gluten could be considered the gold standard for diagnosis