title: Gluten Psychosis: Confirmation of a New Clinical Entity.
abstract: Non-celiac gluten sensitivity (NCGS) is a syndrome diagnosed in patients with symptoms that respond to removal of gluten from the diet, after celiac disease and wheat allergy have been excluded. NCGS has been related to neuro-psychiatric disorders, such as autism, schizophrenia and depression. A singular report of NCGS presenting with hallucinations has been described in an adult patient. We report a pediatric case of a psychotic disorder clearly related to NCGS and investigate the causes by a review of literature. The pathogenesis of neuro-psychiatric manifestations of NCGS is unclear. It has been hypothesized that: (a) a "leaky gut" allows some gluten peptides to cross the intestinal membrane and the blood brain barrier, affecting the endogenous opiate system and neurotransmission; or (b) gluten peptides may set up an innate immune response in the brain similar to that described in the gut mucosa, causing exposure from neuronal cells of a transglutaminase primarily expressed in the brain. The present case-report confirms that psychosis may be a manifestation of NCGS, and may also involve children; the diagnosis is difficult with many cases remaining undiagnosed. Well-designed prospective studies are needed to establish the real role of gluten as a triggering factor in neuro-psychiatric disorders.
authors.affiliation: Department of Pediatrics, University of Catania, Via S. Sofia 78, 95124 Catania, Italy. elenalionetti@inwind.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Lionetti
authors.affiliation: Department of Pediatrics, University of Catania, Via S. Sofia 78, 95124 Catania, Italy. leonardi@unict.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Leonardi
authors.affiliation: Department of Pediatrics, University of Catania, Via S. Sofia 78, 95124 Catania, Italy. franzo.chiara@gmail.com.
authors.forename: Chiara
authors.initials: C
authors.lastname: Franzonello
authors.affiliation: Pediatric Neuro-Psychiatric Unit, G. Gaslini Institute, Via Gerolamo Gaslini 5, 16147 Genova, Italy. margheritamancardi@ospedale-gaslini.ge.it.
authors.forename: Margherita
authors.initials: M
authors.lastname: Mancardi
authors.affiliation: Department of Pediatrics, University of Catania, Via S. Sofia 78, 95124 Catania, Italy. m.ruggieri@unict.it.
authors.forename: Martino
authors.initials: M
authors.lastname: Ruggieri
authors.affiliation: Department of Pediatrics, Marche Polytechnic University, Ancona, Via Corridoni, 11, 60123 Ancona, Italy. c.catassi@univpm.it.|The Division of Paediatric Gastroenterology and Nutrition and Center for Celiac Research, MassGeneral Hospital for Children, 55 Fruit Street, Boston, MA 02114, USA. c.catassi@univpm.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catassi
mesh_terms: D000293:Adolescent; D055050:Diet, Gluten-Free; D005260:Female; D005512:Food Hypersensitivity; D005983:Glutens / Q000009:adverse effects*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D039841:Leukocyte L1 Antigen Complex / Q000097:blood; D011618:Psychotic Disorders / Q000178:diet therapy* / Q000209:etiology*
chemical_list: D007074:Immunoglobulin G; D039841:Leukocyte L1 Antigen Complex; D005983:Glutens
keywords: gluten; hallucinations; non celiac gluten sensitivity; psycosis