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A UK study of the prevalence of coeliac disease in children, aged 7 years,
found:

"At age 7, 1% of children were IgA-EMA positive and likely therefore to
have subclinical coeliac disease, though less than 0.1% were reported to be
on a gluten-free diet. The prevalence of coeliac disease in these children
is therefore comparable to that in UK adults."

Since the prevalence in children seems to be about the same as in adults,
i.e. CD prevalence does NOT increase as a result of becoming an adult, the
trigger for the onset of CD seems to occur very early in child
development.  The study's authors conclude:

"Occult coeliac disease seems to start in childhood, even in those who are
subsequently diagnosed as adults. The search for the trigger resulting in
the breakdown of immune tolerance to gluten therefore needs to focus on
infancy and intrauterine life."

In previous posts I have cited studies showing commensal microflora to be a
necessary component in neonatal gut development and immunity.  Again, the
possible role of microflora in the onset of CD cannot be overlooked.

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BMJ. 2004 Feb 7;328(7435):322-3

Free full text:
http://bmj.bmjjournals.com/cgi/content/full/328/7435/322

Undiagnosed coeliac disease at age seven: population based prospective
birth cohort study.

Bingley PJ, Williams AJ, Norcross AJ, Unsworth DJ, Lock RJ, Ness AR, Jones
RW.

Division of Medicine, University of Bristol, Southmead Hospital, Bristol
BS10 5NB.

PMID: 14764493 [PubMed - in process]

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On another note, for clarity's sake, I would like to take this opportunity
to edit a poorly worded portion of my "Part 1 - Twin Studies" post (words
don't always come out right when you're half asleep):

http://maelstrom.stjohns.edu/CGI/wa.exe?A2=ind0402b&L=celiac&O=D&P=1772

My original statement was:

"While twin studies show there is a high concordance of CD in identical
twins, there are no studies showing that CD eventually occurs in both
identical twins if only one has it at one time.  And this is true in one
study of 5 twin pairs followed up for 11-23 years where 2 of the twins
remained free of CD.  The fact that CD may occur in identical twins at
different times in their lives further supports that environmental factors,
such as commensal microflora, are necessary to trigger the onset of CD."

The properly worded statement should instead read:

"While twin studies show there is a high concordance of CD in identical
twins, there are no studies showing that CD eventually occurs in both
identical twins if only one twin has it at one time.  In one study, 5 twin
pairs were followed-up for 11-23 years.  2 of these twins remained free of
CD throughout the study, belying the idea CD is inevitable.  If, in fact,
CD were to occur in identical twins at different times in their lives, the
occurrence would tend to support the notion that environmental factors,
such as commensal microflora, are necessary to trigger the onset of CD."

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