{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T17:07:13Z","timestamp":1790269633403,"version":"4.1.0"},"reference-count":79,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Palermo"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Wheat or cow\u2019s milk intake might influence the primary Sj\u00f6gren\u2019s Syndrome (pSS) clinical manifestations. A high prevalence (20\u201330%) of autoimmune diseases, including pSS, has been reported in non-celiac wheat sensitivity (NCWS). This study aimed to identify the prevalence of self-reported NCWS and sensitivity\/intolerance to other foods in patients with pSS, and to establish the specific clinical and immunological features of this subgroup of patients. Methods: 82 prospectively enrolled pSS patients were compared to 161 type 2 diabetes controls without rheumatological disease. The presence of a self-reported NCWS, and\/or self-reported milk intolerance (SRMI), and\/or multiple food sensitivity (MFS) was assessed by a validated questionnaire. Clinical and immunological features of pSS subjects, stratified according to the presence\/absence of self-reported NCWS, were analyzed. Results: pSS patients had a higher frequency of self-reported NCWS (47.6% vs. 18.6%, p &lt; 0.0001), SRMI (29.3% vs. 5.6%, p &lt; 0.0001) and MFS (30.5% vs. 9.3% p &lt; 0.0003) compared to controls. After the intake of wheat-containing products, 18 (21.9%) pSS patients reported the worsening of disease-specific symptoms, whereas 11 (13.4%) reported a significative clinical improvement after wheat-free diet (WFD) introduction. Moreover, 47.6% of pSS subjects complained of wheat-related gastrointestinal\/extraintestinal disorders. No clinical\/immunological feature differentiates pSS patients with and without self-reported NCWS, excluding a higher frequency of SRMI (39.5% vs. 11.9%, p = 0.01) and MFS (65.7% vs. 23.8%; p = 0.0004) in the former. Conclusions: This study shows a clear association between pSS and NCWS, confirming that wheat intake could be a common trigger of symptoms of both these conditions. WFD adoption seems to reduce both gastrointestinal\/extraintestinal and pSS-specific symptoms in a subgroup of pSS patients, opening new possibilities for their clinical management.<\/jats:p>","DOI":"10.3390\/nu17193172","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T08:22:08Z","timestamp":1759911728000},"page":"3172","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Self-Reported Non-Celiac Wheat Sensitivity and Other Food Sensitivities in Patients with Primary Sj\u00f6gren\u2019s Syndrome"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4080-2641","authenticated-orcid":false,"given":"Aurelio","family":"Seidita","sequence":"first","affiliation":[{"name":"Unit of Internal Medicine, \u201cV. Cervello\u201d Hospital, Ospedali Riuniti \u201cVilla Sofia-Cervello\u201d, Via Trabucco, 180, 90146 Palermo, Italy"},{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"},{"name":"Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0406-0583","authenticated-orcid":false,"given":"Pasquale","family":"Mansueto","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7850-555X","authenticated-orcid":false,"given":"Maurizio","family":"Soresi","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7327-8121","authenticated-orcid":false,"given":"Diana","family":"Di Liberto","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), Institute of Biochemistry, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"De Carlo","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, \u201cV. Cervello\u201d Hospital, Ospedali Riuniti \u201cVilla Sofia-Cervello\u201d, Via Trabucco, 180, 90146 Palermo, Italy"},{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Bisso","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, \u201cV. Cervello\u201d Hospital, Ospedali Riuniti \u201cVilla Sofia-Cervello\u201d, Via Trabucco, 180, 90146 Palermo, Italy"},{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Cosenza","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, \u201cV. Cervello\u201d Hospital, Ospedali Riuniti \u201cVilla Sofia-Cervello\u201d, Via Trabucco, 180, 90146 Palermo, Italy"},{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirco","family":"Pistone","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, \u201cV. Cervello\u201d Hospital, Ospedali Riuniti \u201cVilla Sofia-Cervello\u201d, Via Trabucco, 180, 90146 Palermo, Italy"},{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9423-5462","authenticated-orcid":false,"given":"Alessandra","family":"Giuliano","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, \u201cV. Cervello\u201d Hospital, Ospedali Riuniti \u201cVilla Sofia-Cervello\u201d, Via Trabucco, 180, 90146 Palermo, Italy"},{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Spagnuolo","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, \u201cV. Cervello\u201d Hospital, Ospedali Riuniti \u201cVilla Sofia-Cervello\u201d, Via Trabucco, 180, 90146 Palermo, Italy"},{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Bertolino","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, \u201cV. Cervello\u201d Hospital, Ospedali Riuniti \u201cVilla Sofia-Cervello\u201d, Via Trabucco, 180, 90146 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clarissa","family":"Bellanti","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Citarrella","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"La Barbera","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"},{"name":"Unit of Rheumatology, University Hospital of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliana","family":"Guggino","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"},{"name":"Unit of Rheumatology, University Hospital of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8913-7916","authenticated-orcid":false,"given":"Antonio","family":"Carroccio","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, \u201cV. Cervello\u201d Hospital, Ospedali Riuniti \u201cVilla Sofia-Cervello\u201d, Via Trabucco, 180, 90146 Palermo, Italy"},{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/00002281-200009000-00007","article-title":"Update in Sj\u00f6gren Syndrome","volume":"12","author":"Fox","year":"2000","journal-title":"Curr. Opin. 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