Symptomatic suspected gluten exposure is common among patients with coeliac disease on a gluten‐free diet

• Published in: Alimentary pharmacology & therapeutics Vol. 44; no. 6; pp. 612 - 619
• Main Authors: Silvester, J. A., Graff, L. A., Rigaux, L., Walker, J. R., Duerksen, D. R.
• Format: Journal Article
• Language: English
• Published: England 01-09-2016
• Subjects: Adult; Celiac Disease - diet therapy; Celiac Disease - epidemiology; Diet, Gluten-Free; Feeding Behavior - physiology; Female; Glutens - adverse effects; Humans; Male; Middle Aged; Patient Compliance - statistics & numerical data; Prevalence; Restaurants - statistics & numerical data; Surveys and Questionnaires
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.13725

Summary
Background
A gluten‐free diet is the only recommended treatment for coeliac disease.
Aim
To determine the prevalence and characteristics of reactions to gluten among persons with coeliac disease on a gluten‐free diet.
Methods
Adults with biopsy proven, newly diagnosed coeliac disease were prospectively enrolled. A survey related to diet adherence and reactions to gluten was completed at study entry and 6 months. The Coeliac Symptom Index, Coeliac Diet Assessment Tool (CDAT) and Gluten‐Free Eating Assessment Tool (GF‐EAT) were used to measure coeliac disease symptoms and gluten‐free diet adherence.
Results
Of the 105 participants, 91% reported gluten exposure <1 per month and median CDAT score was 9 (IQR 8–11), consistent with adequate adherence. A suspected symptomatic reaction to gluten was reported by 66%. Gluten consumption was unsuspected until a reaction occurred (63%) or resulted from problems ordering in a restaurant (29%). The amount of gluten consumed ranged from cross‐contact (30%) to a major ingredient (10%). Median time to symptom onset was 1 h (range 10 min to 48 h), and median symptom duration was 24 h (range 1 h to 8 days). Common symptoms included abdominal pain (80%), diarrhoea (52%), fatigue (33%), headache (30%) and irritability (29%).
Conclusions
Reactions to suspected gluten exposure are common among patients with coeliac disease on a gluten‐free diet. Eating at restaurants and other peoples’ homes remain a risk for unintentional gluten exposure. When following individuals with coeliac disease, clinicians should include questions regarding reactions to gluten as part of their assessment of gluten‐free diet adherence.