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1. Introduction
The spectrum of gluten-related disorders include Wheat Allergy (WA), Celiac Disease (CD), and Non-Celiac Gluten Sensitivity (NCGS). Wheat allergy is strongly linked to anti-wheat IgE antibodies production and mast cells degranulation upon re-exposition to the allergen [1]. CD is an autoimmune-like enteropathy with a strong genetic background. Different from WA and CD, NCGS is not recognized as a strict enteropathy, and it is not linked to the specific arm of the immune system; nonetheless, innate immune mediators could play an important role in the pathogenesis of NCGS [2]. Notably, symptomatic adverse reactions are triggered after the ingestion of wheat in the three conditions, but CD is asymptomatic in many cases. Thus, WA patients should avoid wheat from their diets, but CD and NCGS cases should follow a strict gluten-free diet (GFD) to avoid the symptoms associated to these conditions and/or long-term complications in CD cases.
Algorithms for the diagnosis of WA and CD have been published and accepted by both the scientific community and healthcare professionals [3,4]. The gold standard for oral WA diagnosis is the double-blind placebo-controlled oral challenge (ingestion of wheat), followed by the evaluation of symptoms, while formally diagnosed CD requires the patient to be on a gluten-containing diet and includes gastrointestinal endoscopy with biopsies and further histological analysis (biopsy-proven CD) [5]. Due to the lack of specific biological markers, NCGS diagnosis involves the exclusion of WA and CD, followed by a double-blind placebo-controlled gluten challenge [6]. However, these protocols are not suitable for large-scale population studies, and survey-based studies have emerge as an alternative to evaluate the prevalence of gluten-related disorders at population level [7,8]. Such a survey-based protocol has allowed us to estimate the prevalence of self-reported gluten-related disorders and adherence to a GFD in three Latin American Countries [9,10,11].
Although the GFD is considered a treatment for gluten-related disorders, recent survey studies highlighted that most Latin Americans following a GFD were doing it for reasons other than health-related benefits, and without medical/dietitian advice [9,10], potentially compromising fiber and micronutrients intake [12,13,14]. On the contrary, some Latin Americans that experience recurrent adverse reactions after gluten ingestion were not following the diet. This can be attributed to the mildness of the symptoms triggered, access to gluten-free products, and/or economic...