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.