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Laurin et al. 2002. Even Small Amounts of Gluten Cause Relapse in Children
With Celiac Disease. Jour. of Ped Gastroenterol Nutr. 34: 26-30.

Background:  The study authors aim was to “monitor gluten intake, clinical
symptoms, and antibody kinetics to evaluate the influence of gluten exposure
during the challenge".

Methods;  25 children who were suspected of having CD, ranged in age from
approx. 3 to 9 years old.  Each child was given the same bread which
contained 50% gluten, approx. .6 grams.  Patients were advised to start with
one slice per week and then 3 slices in weeks 2 through 4, and then an
unlimited intake.  The challenge lasted a range from 5 to 51 weeks.

Results:  Symptoms developed from 0-105 days with a mean of 20 days.  Within
one month, almost 89% of the children had clinical symptoms.  The
development of symptoms did not correlate with the increase in the number of
lymphocytes (a type of white blood cell).  (Increased intraepitheial
lymphocytes or IELs are  the early signs of mild intestinal damage, Marsh
type I lesions.  At Marsh type III stage, villous atrophy occurs- Marsh MN,
1992.  Gluten, major histocompatibility complex, and the small lintestine: a
molecular and immunobiologic approach to the spectrum of gluten sensitivity
(‘celiac sprue’). Gastroenterol 102: 330-54).

Most of the children’ weight gain was not as high during the challenge as
when they were on the GFD.  In 22 of 23 children, their IEL count was
increased after the close of the challenge.  21 of 23 biopsy samples had
more severe intestinal damage.
Both IgA and IgG – anti-endomysial and anti-gliadin was tested in the
children.  The IgA-EmA which picked up the most children by biopsy time was
the IgA-EmA, 19 out of 24 children.  At 2 months, 75% of 20 children were
positive on both  IgA-AGA (anti-gliadin) and IgA-EmA.
NO correlation was found between gluten dose, symptom onset, and the
challenge duration.  They noted that some children had symptoms before any
antibody reaction.  However, the authors comment that in another study,
gluten dose dependency was found (Catassi C et al. 1993. Dose dependent
effects of protracted ingestion of small amounts of gliadin in coeliac
disease, Gut 34: 1515-9).  They also indicated that higher doses were
correlated with signs of more severe intestinal damage.  Yet, small amounts
do cause relapse in the signs of intestinal damage.
One interesting comment by the authors was that the parents were advised to
give their children 10 grams of gluten daily during the unlimited amount of
gluten challenge period but often failed to reach this dosage because the
children avoided food with gluten.

Laura Yick






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