Autoimmunity and Celiac Disease

Even though the role of gluten had been identified in the late 40’s, it was not until the mid-80’s that the long-sought after pathogenesis of celiac disease (CD) was finally unveiled. After years of theories (enzymatic deficiencies, lectin-type effect of gluten…) it became finally clear that celiac disease is an autoimmune disorder. A unique type of autoimmune disease, as a matter of fact: indeed, the only one where both, the environmental trigger and the autoantigen have been well identified: gluten, a complex of protein found in wheat, barley, and rye being the environmental trigger, and tissue Transglutaminase (tTG) the auto antigen. Autoimmune diseases tend to share to various extent their genetic bases, so it is no surprise that CD goes hand in hand with other autoimmune disorders, the best known being Type 1 Diabetes (T1D) and autoimmune thyroid diseases (AITD - Hashimoto thyroiditis and Grave’s disease). But the association with autoimmune disorders goes beyond that with endocrine organs, affecting the heart, the joints, the liver, the connective tissue, the skin. We’ll review such associations and their meaning in terms not only of the possible role played by gluten intake before diagnosis to elicit them, but also in practical terms of diagnosis and follow-up.