Gluten-free diet participants, which could have masked the true effect of gluten reintroduction. In a review of May 2015 published in Gastroenterology, Fasano "et al." conclude that besides gluten, ATIs and FODMAPs present in gluten, wheat, barley, rye, and their derivatives play a role in the development of NCGS symptoms. ATIs, which resist proteolytic digestion, may be the inducers of innate immunity in people with coeliac disease or NCGS. FODMAPs cause mild wheat intolerance at most, which is mainly limited to gastrointestinal symptoms. After exclusion of coeliac disease and wheat allergy, the subsequent step for diagnosis and treatment of NCGS is to
Gluten immunochemistry include: LTP (albumin/globulin), thioredoxin-hB, and wheat flour peroxidase. A particular 5 residue peptide, Gln-Gln-Gln-Pro-Pro motif, has been found to be a major wheat allergen. New immunogenic motifs appear in the literature almost monthly and new gliadin and "Triticeae" protein sequences appear that contain these motifs. The HLA DQ2.5 restricted peptide "I I Q P Q Q P A Q" produced approximately 50 hits of identical sequences in NCBI-Blast search is one of a several dozen known motifs whereas only a small fraction of Triticeae gluten variants have been examined. For this reason the immunochemistry is best discussed at the level