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This is interesting, a case of reintroducing gluten to a celiac woman
after a 10 year gluten-free diet with no symptoms of celiac disease
showing up during a 15 month followup study.  It would be interesting if
she remains symptom free in subsequent years.

It does bring up the idea of a gluten-ingesting bacteria link which I
proposed in my article, "Are Commensal Bacteria with a Taste for Gluten
the Missing Link in the Pathogenesis of Celiac Disease?"
http://www.celiac.com/st_prod.html?p_prodid=967 .  In that article I
proposed that a bacteria capable of transporting and internalizing gluten
peptides resistant to breakdown could initiate a T cell immune response to
gluten.  Antigen presenting cells (dendritic cells) might present gluten
peptides internalized by the bacteria along with peptides and chemical
signals from the bacteria to T cells.  The T cells would not be able to
distinguish the gluten peptides from the bacteria peptides and would,
therefore, initiate an immune response to gluten peptides as though they
were components from pathogenic bacteria.  The presence or non-presence of
such a bacteria in twins offered an explanation as to why one identical
twin could develop celiac disease and not the other.

After 10 years on a gluten-free diet, it is possible that the numbers of
such gluten-ingesting bacteria might diminish to a level too few to
initiate a gluten immune response, especially if the bacteria largely
depend on gluten for nutrition.  So, like the twin who does not develop
celiac disease, she remains symptom free.

I urged researchers to look for such gluten-ingesting bacteria in my
article, and I continue to urge such research.  Such bacteria could be
found through the use of immunogold electron microscopy.  This technique
permits gluten peptides to be bound to and labelled with gold particles
which show up as distinct opaque spots under the electron microscope.
Such spots found within microscopic cross sections of fecal bacteria
samples would identify gluten-ingesting bacteria.

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Int J Immunopathol Pharmacol. 2005 Oct-Dec;18(4):709-14.

An attempt of specific desensitising treatment with gliadin in celiac
disease.

Patriarca G, Pogna N, Cammarota G, Schiavino D, Lombardo C, Pollastrini E,
De Pasquale T, Buonomo A, Nocente F, Gazza L, Pietrini D, Miele L, Nucera
E, Gasbarrini G.

Allergology Department, Catholic University Policlinico Gemelli, Rome,
Italy.

Gluten-free diet is the current treatment of celiac disease. We decided to
verify the occurrence of histological and serological modification and/or
clinical manifestations during a gradual and progressive introduction of
gliadin in the diet and if it may induce a tolerance to food, as it occurs
in allergic patients. We studied the case of a celiac woman with complete
clinical and histological remittance after 10 years of gluten free diet.
She took increasing daily doses of gliadin, reaching the final dose of 9 g
of gliadin (15 g of gluten) in 6 months. Then she started a free dietary
regimen. During the 15-month follow-up period esophago-gastro-duodenoscopy
showed normal Kerckring folds and villi. Anti-gliadin, anti-endomysium and
anti-tissue-transglutaminase antibodies, as well as the haematological and
biochemical parameters remained normal. Our results represent a new
approach in research concerning celiac disease, and could provide a future
line of study for its management.

PMID: 16388719 [PubMed - in process]

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