Reply

We thank Volta et al for their interest in our work1 and for their comments and data on the frequency of autoimmune diseases and serum autoantibodies in patients suffering from nonceliac wheat sensitivity (NCWS). These authoritative colleagues have emphasized that celiac disease is a well-established autoimmune condition, and we agree that NCWS is still an undefined syndrome with uncertain pathogenesis

Non-celiac wheat sensitivity: rationality and irrationality of a gluten-free diet in individuals affected with non-celiac disease: a review

Non-celiac gluten or wheat sensitivity (NCWS) is a “clinical entity induced by the ingestion of wheat leading to intestinal and/or extraintestinal symptoms that improve once the wheat-containing foodstuff is removed from the diet, and celiac disease and wheat allergy have been excluded”. This mostly accepted definition raises several points that remain controversial on this condition. In the present review, the authors summarize the most recent advances in the clinic and research on NCWS through an accurate analysis of different studies. We screened PubMed, Medline, Embase, and Scopus using the keywords “non-celiac gluten sensitivity”, “non-celiac wheat sensitivity”, and “diagnosis”. We would like to emphasize two main points, including (A) the controversial clinical and etiological aspects in different trials and experiences with particular attention to the Salerno criteria for the diagnosis of NCWS and (B) the histological aspects. The etiology of NCWS remains controversial, and the relationship with irritable bowel syndrome is obscure. Histologically, the duodenal mucosa may show a variable pattern from unremarkable to a slight increase in the number of T lymphocytes in the superficial epithelium of villi. The endorsement of this disease is based on a positive response to a gluten-free diet for a limited period, followed by the reappearance of symptoms after gluten challenge. The Salerno expert criteria may help to diagnose NCWS accurately. Social media and inaccurate interpretation of websites may jeopardize the diagnostic process if individuals self-label as gluten intolerant

LE AREE INTERNE PER LO SVILUPPO DEL TERRITORIO E LA COMPLEMENTARIT\uc0 DI PROGRAMMI E STRUMENTI FRA LE POLITICHE EUROPEE DI SVILUPPO RURALE E DI COESIONE

Le Aree Interne rappresentano un tema particolarmente importante per la programmazione e la spesa dei fondi comunitari nel periodo 2014-2020 perch\ue9 costituiscono il pi\uf9 grande esempio di complementarit\ue0 fra le Politiche europee di sviluppo rurale e di coesione. Per lo sviluppo di queste Aree \ue8 stata creata una Strategia Nazionale per le Aree Interne (SNAI) che mira alla valorizzazione ed al recupero di tutti quei territori (rurali, montuosi, svantaggiati) dal carattere marginale rispetto alla disponibilit\ue0 e all\u2019offerta di servizi essenziali. La peculiarit\ue0 di tale Strategia \ue8 quella di promuovere lo sviluppo di aree che sono uniformemente distribuite in tutto il comprensorio nazionale a dispetto di un\u2019interpretazione macro-regionale (\u201cSud\u201d, \u201cCentro\u201d e \u201cNord\u201d) del Paese. La SNAI si avvale, a tal fine, di progetti di animazione delle economie locali e di strumenti integrati che prevedono il coinvolgimento di tutti i fondi del Quadro Strategico Comune (in particolare del FESR, del FSE e del FEASR). Le Aree Interne si identificano, in questo scenario, come le unit\ue0 di base dello sviluppo locale e recepiscono sia le risorse destinate alle azioni LEADER (Liaison Entre Actions de D\ue9veloppement de l'\uc9conomie Rurale) sia le proposte di Investimenti Territoriali Integrati (ITI) e di strumenti di sviluppo locale di tipo partecipativo (Community Led Local Development, CLLD) quali modalit\ue0 attuative adottabili nell\u2019ambito delle strategie territoriali regionali o nell\u2019ambito della cooperazione territoriale (art. 35 del reg. UE n. 1305/2013). L\u2019utilizzo di pi\uf9 strumenti che operano in contemporanea attraverso programmi condivisi e progetti plurifondo fa si che le Aree Interne si prefigurino come il pi\uf9 grande esempio di complementarit\ue0 ed integrazione fra politiche e strumenti per la crescita e la convergenza della programmazione europea 2014-2020.Internal Areas are a particularly important theme for EU funds planning and spending in the programming period 2014-2020 because they represent the main example of complementarity between the Rural Development Policy and the Cohesion Policy. For the development of these Areas a National Strategy for Internal Areas has been created, aiming at the promotion and recovery of all those territories (rural, mountainous, deprived) which are marginal with regard to the availability and supply of essential services. The peculiarity of this Strategy is to promote the development of areas that are evenly distributed throughout the national territory in spite of a macro-regional interpretation ("South", "Center" and "North") of the Country. The National Strategy for Internal Areas uses, for this purpose, \u201canimation\u201d projects of local economies and integrated tools that provide the involvement of all funds of the Common Strategic Framework (in particular the ERDF, the ESF and the EAFRD). Internal Areas are, in such a scenario, the basic elements of local development and they receive both the resources allocated to the actions LEADER (Liaison Entre Actions de D\ue9veloppement de l'Economie Rurale) and the proposals for Integrated Territorial Investments (ITI) and the tools of Community Led Local Development (CLLD), as implementation methods adoptable in the regional territorial strategies or the territorial cooperation (art. 35 of Reg. EU n. 1305/2013). The use of multiple tools operating simultaneously through shared programs and multi-funded projects makes Internal Areas the greatest example of complementarity and integration between policies and instruments for the growth and convergence of EU programming 2014-2020

High Proportions of People With Nonceliac Wheat Sensitivity Have Autoimmune Disease or Antinuclear Antibodies.

BACKGROUND & AIMS: There is much interest in wheat sensitivity among people without celiac disease (CD), but little is known about any risks associated with the condition. We evaluated the prevalence of autoimmune diseases (ADs) among patients with nonceliac wheat sensitivity (NCWS), and investigated whether they carry antinuclear antibodies (ANA). METHODS: We performed a retrospective study of 131 patients diagnosed with NCWS (121 female; mean age, 29.1 years) at 2 hospitals in Italy from January 2001 through June 2011. Data were also collected from 151 patients with CD or irritable bowel syndrome (IBS) (controls). Patient medical records were reviewed to identify those with ADs. We also performed a prospective study of 42 patients (38 female; mean age, 34 years) diagnosed with NCWS from July 2011 through March 2014 at 3 hospitals in Italy. One hundred age- and sex-matched subjects with CD or IBS served as controls. Serum samples were collected from all subjects and ANA levels were measured by immunofluorescence analysis. Participants completed a questionnaire and their medical records were reviewed to identify those with ADs. RESULTS: In the retrospective analysis, similar portions of subjects with NCWS (29%) and CD (29%) developed ADs (mainly Hashimoto's thyroiditis, 29 cases), compared with a smaller proportion of subjects with IBS (4%) (P < .001). In the prospective study, 24% of subjects with NCWS, 20% of subjects with CD, and 2% of subjects with IBS developed ADs (P < .001). In the retrospective study, serum samples tested positive for ANA in 46% of subjects with NCWS (median titer, 1:80), 24% of subjects with CD (P < .001), and 2% of subjects IBS (P < .001); in the prospective study, serum samples were positive for ANA in 28% of subjects with NCWS, 7.5% of subjects with CD (P = .02), and 6% of subjects with IBS (P = .005 vs patients with NCWS). ANA positivity was associated with the presence of the HLA DQ2/DQ8 haplotypes (P < .001). CONCLUSIONS: Higher proportions of patients with NCWS or CD develop autoimmune disorders, are ANA positive, and showed DQ2/DQ8 haplotypes compared with patients with IBS