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14-17 Celiac disease has features of both an allergic response and autoimmunity.
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We have already seen how undesirable adaptive immune responses can be elicited by environmental antigens, and how this can cause serious disease in the form of allergic and atopic reactions (see Chapter 14). In this chapter, we examine responses to other medically important categories of antigens—those expressed by the body’s own cells and tissues, by the commensal microbiota, or by transplanted organs. The responses to self antigens or antigens associated with the microbiota that lead to tissue damage and disease are broadly referred to as autoimmunity—although, strictly speaking, disease-causing immune responses to the commensal microbiota are a form of xenoimmunity because the organisms from which the antigens derive are foreign and are not encoded by the human genome. Nevertheless, here we will consider immune-mediated disease directed against the commensal microbiota to be part of the extended spectrum of autoimmune diseases, because the microbiota can be regarded as being part of a ‘superorganism’ made up of host and commensal microbiota together. The response to nonself antigens on transplanted organs is called allograft rejection.