Treatment of celiac disease is based on the avoidance of gluten-containing food.
However, it is not known whether trace amounts of gluten are harmful to treated patients.
Dr Carlo Catassi and colleagues from Italy established the safety threshold of prolonged exposure to trace amounts of gluten.
The research team conducted a multicenter, double-blind, placebo-controlled, randomized trial in 49 adults with biopsy-proven celiac disease.
The patients were being treated with a gluten-free diet for 2 years.
|The percentage change in villous height was -1% in the 10-mg group|
|American Journal of Clinical Nutrition|
The background daily gluten intake was maintained at less than 5 mg.
After a baseline evaluation, patients were assigned to ingest daily for 90 days a capsule containing 0, 10, or 50 mg gluten.
The researchers performed clinical, serologic, and histologic evaluations of the small intestine at baseline evaluation, and after the gluten microchallenge.
At baseline evaluation, the median villous height or crypt depth in the small-intestinal mucosa was significantly lower.
The research team found that the intraepithelial lymphocyte count was higher in celiac patients than in 20 controls without celiac disease.
The team noted that 1 patient developed a clinical relapse.
The research team found that at gluten microchallenge, the percentage change in villous height or crypt depth was 9% in the placebo group.
At gluten microchallenge, the percentage change in villous height or crypt depth was -1% in the 10-mg group, and -20% in the 50-mg group.
The team observed that no significant differences in the intraepithelial lymphocyte count were found between the 3 groups.
Dr Catassi's team concludes, “The ingestion of contaminating gluten should be kept lower than 50 mg/d in the treatment of celiac disease.”