Gluten hypersensitivity: basophil activation test (BAT) may help in the differential diagnosis?

The main forms of gluten-related disorders are wheat allergy (WA), celiac disease (CD) and possibly immune-mediated disease (gluten sensitivity). S-IgE play an essential role in WA. For CD tests available are anti-tissue transglutaminase (tTG) IgA, anti-endomysium (EMA) and deamidated gliadin peptides (DGP) antibodies IgG particular. For other immune-mediated diseases there is currently no test available. The usefulness of basophil activation test (BAT) in anaphylactic adverse reactions, late-onset allergy has been demonstrated. We report the case of a woman of 46 years old with disorders of wheat tied overt clinical signs, intestinal and extra-intestinal symptoms, whose tests above were all negative. Only the BAT showed a stimulation of basophils exposed (52.9%) to extract wheat. We diagnosed gluten sensitivity (GS) on the basis of an algorithm for the differential diagnosis of gluten-related disorders, including CD, GS and WA. We believe that the BAT confirms a hypersensitivity reaction to wheat not-IgE-mediated, not CD.