Introduction and objective:
Coeliac disease is a chronic autoimmune disorder of the small intestine that develops in genetically predisposed individuals (HLA-DQ2/DQ8) following gluten exposure. Although genetic factors play a pivotal role in its pathogenesis, the rising incidence observed over recent decades suggests that environmental factors also contribute. The aim of the review is to analyze recent data regarding the influence of air pollution and heavy metal exposure on the risk and course of coeliac disease in children and adolescents.

Brief description of the state of knowledge:
An increasing number of studies indicate that heavy metals and air pollutants may contribute to the development and progression of coeliac disease. Nanoparticles of silver, titanium dioxide, and gold disrupt the gut microbiota, damage the intestinal barrier, and activate the immune system, elevating pro-inflammatory cytokines such as IL-15, IFN-γ, and IL-8. Exposure to heavy metals is associated with over-representation of Bacteroides and Firmicutes, impaired tight junctions, and disrupted autophagy in enterocytes, all promoting intestinal injury. Individuals on gluten-free diets, especially those rich in rice-based products, may accumulate more heavy metals, exacerbating mucosal damage. Likewise, pollutants like nitrogen dioxide, particulate matter, and ozone weaken gut integrity, alter immune responses, and are linked to increased coeliac disease prevalence, particularly in children in polluted areas.

Summary:
Heavy metals and air pollution may alter the intestinal microenvironment, epithelial barrier function, and immune response, representing potential risk factors for the development of coeliac disease. Their role in the disease’s pathogenesis warrants further multicentre, multidisciplinary research.