Gluten free pasta, one of the few foods that you can generally make taste as good as the regular version.

Despite the explosion of gluten-free food in the last few years, actually being on a physician-prescribed GF diet isn’t easy. Millions of people with celiac disease spend their lives fretting over cross-contamination at restaurants and scrutinizing labels. It’s a lot of paranoia and watching other people eat cake. Worst of all, despite interrogating waiters about which foods are safe to eat, sometimes you get glutened anyway.

For all these reasons, physicians and researchers who work with celiac patients know that staying on a gluten-free diet isn’t the simple fix that it appears to be. That’s why a company called ImmusanT has been developing an alternative: a vaccine.

We usually think of vaccines as useful for battling viruses, not autoimmune diseases, but the theory behind ImmusanT’s Nexvax2 seems sound so far. Like a normal shot, Nexvax2 exposes a patient’s immune system to a small quantity of what would otherwise be a dangerous substance. For standard vaccines, that’s a virus, but for Nexvax2 it’s gluten.

To really understand how it works, though, we have to dive a little further into what celiac actually is, because contrary to popular belief it’s not an allergy. Allergies are essentially an overreaction to something that your body is supposed to consider harmless. If you’re allergic to milk, your immune system thinks milk proteins are dangerous and will release a ton of histamines in response to their presence. This flood of histamines causes the symptoms of the allergy (some so-called allergies are actually intolerances related to how the gut breaks down certain foods, like alliums, but still aren’t autoimmune in nature). Celiac patients’ immune systems have also mischaracterized a protein, in this case gluten proteins, as being dangerous, but instead of releasing a bunch of histamines it starts attacking itself.

When people with celiac eat gluten they don’t get wheezy—they experience gastrointestinal distress as their immune systems attack their intestinal lining. If there’s enough gluten, this response damages the delicate fingers called villi that normally absorb nutrients from food. Celiac patients with damaged villi can end up malnourished if this goes on for long enough.

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