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April 18, 2014

Gluten and the prevention of coeliac disease

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Experts have launched a study on a “window of opportunity” to prevent coeliac disease (CD) by introducing gluten into babies’ diets.

The PreventCD Study is based on genome-wide association studies that have identified 26 non-HLA loci that might be involved in the development of CD. It will assess the early immunological response to gluten and aims to reduce the incidence of CD through primary prevention.

Dr Caroline Esch and colleagues from the Leiden University Medical Centre in the Netherlands noted previous research suggesting a window of opportunity for preventing CD by introducing gluten into the child’s diet by the age of four to six months.

One part of the study will follow two Swedish cohorts of children to the age of 12 years. Half were born in 2005/2006 when the feeding of gluten to infants was actively discouraged, and half in 2009/2010 when gradual introduction of gluten at four-to-six months, preferably while still breastfeeding, was encouraged.

A second component of the study will enrol at least 1,000 newborns who have a first-degree relative with CD. At three months of age, those positive for HLA-DQ2 and/or HLA-DQ8 will be randomised to either 100mg or 2g of gluten daily for eight weeks from age four months.

They will be tested for gliadin IgA and antihuman tissue transglutaminase IgA. Breast milk samples will be collected monthly and analysed for gluten content.

The authors said the view that CD was unavoidable in susceptible people had been challenged by several studies, and the PreventCD project was an innovative research project on primary prevention.

Eur J Gastroenterol Hepatol 2010;22:1424-1430