By: Joann Schulte DO, MPH; Editorial Board Member
Gluten-free dining and groceries are a growth industry these
days. Multiple restaurants, both of Some charge a higher price for gluten-free
items that can include everything from pizza to Mongolian beef to the flourless
chocolate cake. Such items have to be
prepared carefully so there’s no cross-contamination in the kitchen from wheat
or barley. There’s even a class-action lawsuit that’s been filed in California,
claiming that the extra charges and higher prices are a violation of the
Americans with Disabilities Act the
gourmet type and the chain variety, spout their gluten-free menus.
The availability of such diets and grocery choices is good
news for patients with celiac disease (CD), including the children who are
often diagnosed after prolonged complaints of abdominal pain, diarrhea, failure
to thrive and nutritional deficiencies.
About 1% of the US population is estimated to have celiac disease, and
new research published this month in Pediatrics
documents risk factors associated with the disease among a birth cohort
followed in six clinical centers located in four countries.
Agardh et al. (
doi:10.1542/peds.2014-3675) followed a group of 6,706 children who were positive for HLA-DR3-DQ2
and/or DR4-DQ8.
Those HLA types have
been associated with a higher risk of celiac disease.
The children were screened annually for
tissue transglutaminase antibodies (tTGA) and screened for symptoms via
questionnaires.
Those questionnaires
include an assessment of abdominal discomfort, anemia, chronic constipation, loose
stools, vomiting and poor growth.
The researchers
also collected information about children’s height, weight and body mass index.
The researchers found a 5% incidence of CD among children with HLA types linked
to the disorder.
Among the screened children, 914 developed persistent
positive tTGA, 406 underwent intestinal biopsies and 304 were diagnosed with
CD. The researchers compared their
pediatric subjects with age-matched children who were tTGA negative. The children who were persistently positive
were more likely to have symptoms at ages 2 and 3 years and to have higher
levels of tTGA at seroconversion. The
levels of tTGA correlated with the severity of mucosal lesions in both
symptomatic and asymptomatic children.
In a related commentary, Dr. Richard Noel (
doi:10.1542/peds.2015-0209) suggests that
the study offers a tiered approach to CD diagnosis.
The 2-tiered approach of early genetic
screening for genetic susceptibility and later screening for the celiac
antibodies has been proposed.
Currently
an individual physician must undertake the testing.
The study suggests a possible case-finding
strategy in a disease that may be more easily managed given the attention it is
getting both from medicine and the food industry.
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