Skip to main content

Advertisement

Log in

Cutting-Edge Issues in Celiac Disease and in Gluten Intolerance

  • Published:
Clinical Reviews in Allergy & Immunology Aims and scope Submit manuscript

Abstract

Celiac disease (CD) is a gluten-dependent immune-mediated disease with a prevalence in the general population estimated between 0.3% and 1.2%. Large-scale epidemiological studies have shown that only 10–20% of cases of CD are identified on the basis of clinical findings and that laboratory tests are crucial to identify subjects with subtle or atypical symptoms. The correct choice and clinical use of these diagnostic tools may enable accurate diagnosis and early recognition of silent CD cases. In this review, we have considered some relevant aspects related to the laboratory diagnosis of CD and, more extensively, of gluten intolerance, such as the best combination of tests for early and accurate diagnosis, the diagnostic role of new tests for detecting antibodies against neoepitopes produced by the transglutaminase–gliadin complex, the forms of non-celiac gluten intolerance (gluten sensitivity), and the use and significance of measuring cytokines in CD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Catassi C, Ratsch IM, Fabiani E et al (1994) Coeliac disease in the year 2000: exploring the iceberg. Lancet 343:200–203

    Article  PubMed  CAS  Google Scholar 

  2. Rostom A, Murray JA, Kagnoff MF (2006) American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease. Gastroenterology 131:1981–2002

    Article  PubMed  Google Scholar 

  3. Rostom A, Dubè C, Cranney A et al (2005) The diagnostic accuracy of serological test for celiac disease: a systematic review. Gastroenterology 128:S38–S46

    Article  PubMed  Google Scholar 

  4. Not T, Horvath K, Hill ID et al (1998) Celiac disease risk in the USA: high prevalence of antiendomysium antibodies in healthy blood donors. Scand J Gastroenterol 33:494–498

    Article  PubMed  CAS  Google Scholar 

  5. Dieterich W, Laag E, Schopper H et al (1998) Autoantibodies to tissue transglutaminase as predictors of celiac disease. Gastroenterology 115:1317–1321

    Article  PubMed  CAS  Google Scholar 

  6. Tonutti E, Visentini D, Bizzaro N et al (2003) The role of anti-tissue transglutaminase assay for the diagnosis and monitoring of coeliac disease: a French–Italian multicentre study. J Clin Pathol 56:389–393

    Article  PubMed  CAS  Google Scholar 

  7. Mustalahti K, Catassi C, Reunanen A, Coeliac EU Cluster, Project Epidemiology et al (2010) The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Ann Med 42:587–595

    Article  PubMed  Google Scholar 

  8. Catassi C, Kryszak D, Bhatti B et al (2010) Natural history of celiac disease autoimmunity in a USA cohort followed since 1974. Ann Med 42:530–538

    Article  PubMed  Google Scholar 

  9. Lohi S, Mustalahti K, Kaukinen K et al (2007) Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther 26:1217–1225

    Article  PubMed  CAS  Google Scholar 

  10. Kurrpa K, Ashorn M, Iltanen S et al (2010) Celiac disease without villous atrophy in children: a prospective study. J Pediatr 157(3):378.e1–380.e1

    Google Scholar 

  11. Hill ID, Dirks MH, Liptak GS et al (2005) Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Ped Gastroenterol Nutr 40:1–19

    Article  Google Scholar 

  12. Sjostrom H, Lundin KEA, Molberg O et al (1998) Identification of a gliadin T cell epitope in coeliac disease: general importance of gliadin deamidation for intestinal T recognition. Scand J Immunol 48:111–115

    Article  PubMed  CAS  Google Scholar 

  13. Molberg O, McAdam SN, Korner R et al (1998) Tissue transglutaminase selectively modifies gliadin peptides that are recognized by gut-derived T cells in celiac disease. Nat Med 4:713–717

    Article  PubMed  CAS  Google Scholar 

  14. Aleanzi M, Demonte AM, Esper C, Garcilazo S, Waggener M (2001) Celiac disease: antibody recognition against native and selectively deamidated gliadin peptides. Clin Chem 47:2023–2028

    PubMed  CAS  Google Scholar 

  15. Schwertz E, Kahlenberg F, Sack U et al (2004) Serological assay based on gliadin-related nonapeptides as a highly sensitive and specific diagnostic aid in celiac disease. Clin Chem 50:2370–2375

    Article  PubMed  CAS  Google Scholar 

  16. Sugai E, Vazquez H, Nachman F et al (2006) Accuracy of testing for antibodies to synthetic gliadin-peptides in celiac disease. Clin Gastroenterol Hepatol 4:1112–1117

    Article  PubMed  CAS  Google Scholar 

  17. Kaukinen K, Collin P, Laurila K, Kaartinen T, Partanen J, Maki M (2007) Resurrection of gliadin antibodies in coeliac disease. Deamidated gliadin peptide antibody test provides additional diagnostic benefit. Scand J Gastroenterol 42:1428–1433

    Article  PubMed  CAS  Google Scholar 

  18. Niveloni S, Sugai E, Cabanne A, Vazquez H, Argonz J, Smecuol E et al (2007) Antibodies against synthetic deamidated gliadina peptides as predictors of celiac disease: prospective assessment in an adult population with a high pretest probability of disease. Clin Chem 53:2186–2192

    Article  PubMed  CAS  Google Scholar 

  19. Carlsson AK, Axelsson IE, Borulf SK et al (2001) Serological screening for celiac disease in healthy 2.5-year-old children in Sweden. Pediatrics 107:42–45

    Article  PubMed  CAS  Google Scholar 

  20. Lagerqvist C, Dahlbom I, Hansson T et al (2008) Antigliadin immunoglobulin A best in finding celiac disease in children younger than 18 months of age. J Ped Gastroenterol Nutr 47:428–435

    Article  CAS  Google Scholar 

  21. Maglio M, Tosco A, Paparo F et al (2010) Serum and intestinal celiac disease-associated antibodies in children with celiac disease younger than 2 years of age. J Ped Gastroenterol Nutr 50:43–48

    Article  CAS  Google Scholar 

  22. Simell S, Kupila A, Hoppu S et al (2005) Natural history of transglutaminase autoantibodies and mucosal changes in children carrying HLA-conferred celiac disease susceptibility. Scand J Gastroenterol 40:1182–1191

    Article  PubMed  CAS  Google Scholar 

  23. Liu E, LI M, Emery L, Taki I, Barriga K, Tiberti C et al (2007) Natural history of antibodies to deamidated gliadin peptides and transglutaminase in early childhood celiac disease. J Ped Gastroenterol Nutr 45:293–300

    Article  CAS  Google Scholar 

  24. Agardh D (2007) Antibodies against synthetic deamidated gliadin peptides and tissue transglutaminase for the identification of childhood celiac disease. Clin Gastroenterol Hepatol 5:1276–1281

    Article  PubMed  CAS  Google Scholar 

  25. Basso D, Guariso G, Fogar P et al (2009) Antibodies against synthetic deamidated gliadin peptides for celiac disease diagnosis and follow-up in children. Clin Chem 55:150–157

    Article  PubMed  CAS  Google Scholar 

  26. Naiyer AJ, Hernandez L, Ciaccio EJ et al (2009) Comparison of commercially available serologic kits for the detection of celiac disease. J Clin Gastroenterol 43:225–232

    Article  PubMed  CAS  Google Scholar 

  27. Villalta D, Alessio MG, Tampoia M et al (2007) Testing for IgG class antibodies in celiac disease patients with selective IgA deficiency. A comparison of the diagnostic accuracy of 9 IgG anti-tissue transglutaminase, 1 IgG anti-gliadin and 1 IgG anti-deamidated gliadin peptide antibody assays. Clin Chim Acta 382:95–99

    Article  PubMed  CAS  Google Scholar 

  28. Tozzoli R, Kodermaz G, Tampoia M, Visentini D, Tonutti E, Bizzaro N (2010) [Detection of autoantibodies specific for transglutaminase-gliadin peptides complex: a new way to explore the celiac iceberg?] It. J Lab Med 6:28–35

    CAS  Google Scholar 

  29. Clemente MG, Musu MP, Frau F et al (2000) Immune reaction against the cytoskeleton in celiac disease. Gut 47:520–526

    Article  PubMed  CAS  Google Scholar 

  30. Clemente MG, Musu MP, Troncone R et al (2004) Enterocyte actin antibody detection: a new diagnostic tool in celiac disease diagnosis. Results of a multicenter study. Am J Gastroenterol 99:1551–1556

    Article  PubMed  CAS  Google Scholar 

  31. Granito A, Muratori P, Cassani F et al (2004) Anti-actin IgA antibodies in severe coeliac disease. Clin Exp Immunol 137:386–392

    Article  PubMed  CAS  Google Scholar 

  32. Carroccio A, Brusca I, Iacono G et al (2005) Anti-actin antibodies in celiac disease: correlation with intestinal mucosa damage and comparison of ELISA with the immunofluorescence assay. Clin Chem 51:917–920

    Article  PubMed  CAS  Google Scholar 

  33. Carroccio A, Brusca I, Iacono G et al (2007) IgA anti-actin antibodies ELISA in coeliac disease: a multicentre study. Dig Liver Dis 39:818–823

    Article  PubMed  CAS  Google Scholar 

  34. Tonutti E, Visentini D, Picierno A et al (2009) Diagnostic efficacy of the ELISA test for the detection of deamidated anti-gliadin peptide antibodies in the diagnosis and monitoring of celiac disease. J Clin Lab Anal 23:165–171

    Article  PubMed  CAS  Google Scholar 

  35. Villalta D, Tonutti E, Prause C et al (2010) IgG antibodies against deamidated gliadin peptides for diagnosis of celiac disease in patients with IgA deficiency. Clin Chem 56:464–468

    Article  PubMed  CAS  Google Scholar 

  36. Volta U, Fabbri A, Parisi C (2010) Deamidated gliadin peptide antibodies as a routine test for celiac disease: a prospective analysis. J Clin Gastroenterol 44:186–190

    Article  PubMed  Google Scholar 

  37. Tursi A, Brandimarte G, Giorgietti GM et al (2006) Endoscopic and histological findings in the duodenum of adults with celiac disease before and after changing to a gluten-free diet: a 2-year prospective study. Endoscopy 38:702–707

    Article  PubMed  CAS  Google Scholar 

  38. Biagi F, Pezzimenti D, Campanella J, Vadacca GB, Corazza GR (2001) Endomysial and tissue transglutaminase antibodies in coeliac sera: a comparison not influenced by previous serological testing. Scand J Gastroenterol 36:955–958

    Article  PubMed  CAS  Google Scholar 

  39. Lock RJ, Stevens S, Pitcher MC, Unsworth DJ (2004) Is immunoglobulin A anti-tissue transglutaminase antibody a reliable serological marker of coeliac disease? Eur J Gastroenterol Hepatol 16:467–470

    Article  PubMed  CAS  Google Scholar 

  40. Baudon JJ, Johanet C, Absalon YB, Morgant G, Cabrol S, Mougenot JF (2004) Diagnosing celiac disease: a comparison of human tissue transglutaminase antibodies with antigliadin and antiendomysium antibodies. Arch Pediatr Adolesc Med 158:584–588

    Article  PubMed  Google Scholar 

  41. Tonutti E, Bizzaro N, Villalta D, Tozzoli R, Tampoia M (2009) Laboratory diagnosis of coeliac disease. Autoimmun Highlights 0:15–21

    Google Scholar 

  42. Visser J, Rozing J, Sapone A, Lammers K, Fasano A (2009) Tight junctions, intestinal permeability, and autoimmunity. Celiac disease and type 1 diabetes paradigms. Ann NY Acad Sci 1165:195–205

    Article  PubMed  CAS  Google Scholar 

  43. Fleckenstein B, Qiao SW, Larsen MR, Jung G, Roepstorff P, Sollid LM (2004) Molecular characterization of covalent complexes between tissue transglutaminase and gliadin peptides. J Biol Chem 79:17607–17616

    Article  Google Scholar 

  44. Ciccocioppo R, Di Sabatino A, Ara C et al (2003) Gliadin and tissue transglutaminase complexes in normal and coeliac duodenal mucosa. Clin Exp Immunol 134:516–524

    Article  PubMed  CAS  Google Scholar 

  45. Mattias T, Pfeiffer S, Selmi C, Gershwin ME (2010) Diagnostic challenges in celiac disease and the role of the tissue transglutaminase-neo-epitope. Clin Rev Allergy Immunol 38:298–301

    Article  Google Scholar 

  46. Pinkas DM, Strop P, Brunger AT, Khosla C (2007) Transglutaminase 2 undergoes a large conformational change upon activation. PLoS Biol 5:2788–2796

    Article  CAS  Google Scholar 

  47. Remes-Troche JM, Ramirez-Iglesias MT, Rubio-Tapia A, Alonso-Ramos A, Velazquez A, Uscanga LF (2006) Celiac disease could be a frequent disease in Mexico: prevalence of tissue transglutaminase antibody in healthy blood donors. J Clin Gastroenterol 40:697–700

    Article  PubMed  Google Scholar 

  48. Remes-Troche JM, Rios-Vaca A, Ramirez-Iglesias MT et al (2008) High prevalence of celiac disease in Mexican Mestizo adults with type 1 diabetes mellitus. J Clin Gastroenterol 42:460–465

    Article  PubMed  CAS  Google Scholar 

  49. Tozzoli R, Kodermaz G, Porcelli B, et al. (2010) Clinical relevance and diagnostic accuracy of a new ELISA method for the detection of autoantibodies to the gliadin-transglutaminase complex. Proceedings of the 7th International Congress on Autoimmunity, Liubljana, 5–9 May 2010

  50. Tonutti E, Visentini D, Fabris M, et al. (2010) Antibodies to the transglutaminase–deamidated gliadin peptides complex: a new serological approach to the diagnosis of celiac disease. Proceedings of the 7th International Congress on Autoimmunity, Ljubljana, 5–9 May 2010

  51. Reeves GEM, Squance ML, Duggan AE et al (2006) Diagnostic accuracy of celiac serological tests: a prospective study. Eur J Gastroenterol Hepatol 18:493–501

    Article  PubMed  Google Scholar 

  52. Catassi C, Fasano A (2008) Celiac disease. Curr Opin Gastroenterol 24:687–691

    Article  PubMed  Google Scholar 

  53. Anderson LA, McMillan S, Watson RG et al (2007) Maligancy and mortality in a population-based color of patients with coeliac disease or ‘gluten sensitivity’. World J Gastroenterol 13:146–151

    PubMed  CAS  Google Scholar 

  54. Kaukinen K, Tujanmmaa K, Mäki M et al (2000) Intolerance to cereals is not specific for celiac disease. Scand J Gastroenterol 35:942–946

    Article  PubMed  CAS  Google Scholar 

  55. Clemente MG, De Virgiliis S, Kang JS et al (2003) Early effects of gliadin on enterocyte intracellular signalling involved in intestinal barrier function. Gut 52:218–223

    Article  PubMed  CAS  Google Scholar 

  56. Sapone A, Lammers KM, Mazzarela G et al (2010) Differential mucosal IL-17 expression in two gliadin-induced disorders: gluten sensitivity and the autoimmune enteropathy celiac disease. Int Arch Allergy Immunol 152:75–80

    Article  PubMed  CAS  Google Scholar 

  57. Ferguson A, Gillett H, Humphreys K, Kingstone K (1998) Heterogeneity of celiac disease: clinical, pathological, immunological, and genetic. Ann NY Acad Sci 859:112–120

    Article  PubMed  CAS  Google Scholar 

  58. Catassi C, Fasano A (2008) Is this really celiac disease? Pitfalls in diagnosis. Curr Gastroenterol Rep 10:466–472

    Article  PubMed  Google Scholar 

  59. Fabris M, Visentini D, Da Re V et al (2007) Elevated B cell-activating factor of the tumor necrosis factor family in coeliac disease. Scand J Gastroenterol 42:1434–1439

    Article  PubMed  CAS  Google Scholar 

  60. Fabris M, De Vita S, Visentini D et al (2009) B-Lymphocyte stimulator and a proliferation-inducing ligand serum levels in IgA-deficient patients with and without celiac disease. Ann NY Acad Sci 1173:268–273

    Article  PubMed  CAS  Google Scholar 

  61. Sapone A, Giuliano MT, Cammarota M et al (2009) Gluten sensitivity is associated to activation of the innate but not adaptive immune response to gluten exposure. Gastroenterology 136(1):5–413

    Google Scholar 

  62. Hadjivassiliou M, Chattopadhyay AK, Grünewald RA et al (2007) Myopathy associated with gluten sensitivity. Muscle Nerve 35:443–450

    Article  PubMed  CAS  Google Scholar 

  63. Ford RPK (2009) The gluten syndrome: a neurological disease. Med Hypotheses 73:438–440

    Article  PubMed  CAS  Google Scholar 

  64. Elder JH (2008) The gluten-free, casein-free diet in autism: an overview with clinical implication. Nutr Clin Pract 23:583–588

    Article  PubMed  Google Scholar 

  65. Dikerson F, Stallings C, Origoni A et al (2010) Markers of gluten sensitivity and celiac disease in recent-onset psychosis and multi-episode schizophrenia. Biol Psychiatry 68:100–104

    Article  Google Scholar 

  66. Verdu EF, Armstrong D, Murray JA (2009) Between celiac disease and irritable bowel syndrome: the “non man’s land” of gluten sensitivity. Am J Gastroenterol 104:1587–1594

    Article  PubMed  Google Scholar 

  67. Meresse B, Cerf-Bensussan N (2009) Innate T cell responses in human gut. Semin Immunol 21:121–129

    Article  PubMed  CAS  Google Scholar 

  68. Palmer E (2007) The generation of T cell tolerance. Swiss Med Wkly 137(suppl 155):99S–100S

    PubMed  Google Scholar 

  69. Maiuri L, Ciacci C, Ricciardelli I et al (2003) Association between innate response to gliadin and activation of pathogenic T cells in coeliac disease. Lancet 362:30–37

    Article  PubMed  CAS  Google Scholar 

  70. Londei M, Ciacci C, Ricciardelli I et al (2005) Gliadin as stimulator of innate responses in celiac disease. Mol Immunol 42:913–918

    Article  PubMed  CAS  Google Scholar 

  71. Schuppan D, Junker Y, Barisani D et al (2009) Celiac disease: from pathogenesis to novel therapies. Gastroenterol 137:912–933

    Article  Google Scholar 

  72. Meresse B, Verdier J, Cerf-Bensussan N (2008) The cytokine interleukin 21: a new player in coeliac disease? Gut 57:879–881

    Article  PubMed  CAS  Google Scholar 

  73. De la Concha EG, Fernandez-Arquero M, Vigil P et al (2000) Celiac disease and TNF promoter polymorphism. Hum Immunol 61:513–517

    Article  PubMed  Google Scholar 

  74. Maki M, Collin P (1997) Coeliac disease. Lancet 349:200–203

    Article  Google Scholar 

  75. Uibo O, Lambrechts A, Mascart-Lemone F (1995) Human oesophagus: a convenient antigenic substrate for the autoantibodies in the serological diagnosis of coeliac disease. Eur J Gastroenterol Hepatol 7:37–40

    PubMed  CAS  Google Scholar 

  76. Catassi C (2005) Where is celiac disease coming from and why? J Pediatr Gastroenterol Nutr 40:279–282

    Article  PubMed  Google Scholar 

  77. Schuppan D (2000) Current concepts of celiac disease pathogenesis. Gastroenterology 119:234–242

    Article  PubMed  CAS  Google Scholar 

  78. Salvati VM, Mac Donald TT, Bajaj-Elliott M et al (2002) Interleukin 18 and associated markers of T helper cell type 1 activity in coeliac disease. Gut 50:186–190

    Article  PubMed  CAS  Google Scholar 

  79. Przemioslo RT, Lundin KEA, Sollid LM, Nelufer J, Ciclitira PJ (1995) Histological changes in small bowel mucosa induced by gliadin sensitive T lymphocytes can be blocked by anti-interferon antibody. Gut 36:874–879

    Article  PubMed  CAS  Google Scholar 

  80. Leon AJ, Garrote JA, Blanco-Quiros A et al (2006) Interleukin 18 maintains a long-standing inflammation in coeliac disease patients. Clin Exp Immunol 146:479–485

    Article  PubMed  CAS  Google Scholar 

  81. De Nitto D, Monteleone I, Franzè E, Pallone F, Monteleone G (2009) Involvement of interleukin-15 and interleukin-21, two gamma-chain-related cytokines, in celiac disease. World J Gastroenterol 15:4609–4614

    Article  PubMed  Google Scholar 

  82. Garrote JA, Gomez-Gonzales E, Bernardo D, Arranz E, Chirdo F (2008) Celiac disease pathogenesis: the proinflammatory cytokine network. J Pediatr Gastroenterol Nutr 47:27–32

    Article  Google Scholar 

  83. Mackay F, Mackay CR (2002) The role of BAFF in B-cell maturation, T-cell activation and autoimmunity. Trends Immunol 23:113–115

    Article  PubMed  CAS  Google Scholar 

  84. Mackay F, Woodcock SA, Lawton P et al (1999) Mice transgenic for BAFF develop lymphocytic disorders along with autoimmune manifestations. J Exp Med 190:1697–1710

    Article  PubMed  CAS  Google Scholar 

  85. Sthol W (2002) B lymphocyte stimulator protein levels in systemic lupus erythematosus and other diseases. Curr Rheumatol Resp 4:345–350

    Article  Google Scholar 

  86. Seyler TM, Park YW, Takemura S et al (2005) BLyS and APRIL in rheumatoid arthritis. J Clin Invest 115:3083–3092

    Article  PubMed  CAS  Google Scholar 

  87. Mariette X, Roux S, Zhang J et al (2003) The level of BLyS (BAFF) correlates with the titre of autoantibodies in human Sjogren’s syndrome. Ann Rheum Dis 62:168–171

    Article  PubMed  CAS  Google Scholar 

  88. Fabris M, Quartuccio L, Sacco S et al (2007) B-lymphocyte simulator (BLys) up-regulation in mixed cryoglobulinaemia syndrome and hepatitis-C virus infection. Rheumatology 46:37–43

    Article  PubMed  CAS  Google Scholar 

  89. Nardelli B, Belvedere O, Roschke V et al (2001) Synthesis and release of B-lymphocyte stimulator from myeloid cells. Blood 97:198–204

    Article  PubMed  CAS  Google Scholar 

  90. Batten M, Groom J, Cachero TG et al (2000) BAFF mediates survival of peripheral immature B lymphocytes. J Exp Med 192:1453–1466

    Article  PubMed  CAS  Google Scholar 

  91. Daum S, Bauer U, Foss HD et al (1999) Increased expression of mRNA for matrix metalloproteases-1 and -3 and tissue inhibitor of metalloproteases-1 in intestinal biopsy specimens from patients with celiac disease. Gut 44:17–25

    Article  PubMed  CAS  Google Scholar 

  92. Westerholm-Ormio M, Garioch J, Ketola I, Savilahti E (2002) Inflammatory cytokines in small intestinal mucosa of patients with potential celiac disease. Clin Exp Immunol 128:94–101

    Article  PubMed  CAS  Google Scholar 

  93. Penedo-Pita M, Peteiro-Cartelle J (1991) Increased serum levels of interleukin-2 and soluble interleukin-2 receptor in celiac disease. J Pediatr Gastroenterol Nutr 12:50–60

    Article  Google Scholar 

  94. Bianco A, Garrote JA, Arranz E, Alfonso M, Clavo C (2002) Increased serum IL-2R levels in coeliac disease are related to CD4 but not CD8 antigens. J Pediatr Gastroenterol Nutr 15:413–417

    Google Scholar 

  95. Cinova J, Pavlova-Jelinkova L, Smythies LE et al (2007) Gliadin peptides activate blood monocytes from patients with celiac disease. J Clin Immunol 27:201–209

    Article  PubMed  CAS  Google Scholar 

  96. Manavalan JS, Hernandez L, Shah JG et al (2010) Serum cytokine elevations in celiac disease: association with disease presentation. Hum Immunol 71:50–57

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to N. Bizzaro.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bizzaro, N., Tozzoli, R., Villalta, D. et al. Cutting-Edge Issues in Celiac Disease and in Gluten Intolerance. Clinic Rev Allerg Immunol 42, 279–287 (2012). https://doi.org/10.1007/s12016-010-8223-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12016-010-8223-1

Keywords

Navigation