The introduction of wheat can prevent celiac disease

Very early introduction of high doses of gluten was associated with a reduced prevalence of celiac disease at age 3. Tolerance question (EAT) Infant food allergy prevention test.

Infants in the analysis, randomized to the early gluten introduction group in the study, had not developed celiac disease by age 3. Difference 1.4 percentage points, 95% CI 0.6-2.6; P= 0.02).

Previous randomized trials investigating childhood gluten consumption for the prevention of celiac disease showed little or no association between the timing of wheat introduction and the prevalence of the disease, The results of the EAT trial analysis “suggest that discounting the effect may be premature, the effect of age on gluten introduction on the development of celiac disease,” said Gideon Luck, MB, BCh, and colleagues at King’s College London. reported.

Writing JAMA PediatricsThe researchers concluded that “new randomized clinical trials are needed to address the question of whether early introduction of high-dose gluten is an effective strategy for the prevention of celiac disease.”

Dr. Luci Gupta, a pediatric food allergy specialist and researcher at Northwestern University in Chicago, who was not involved in the analysis MedPage today Findings suggest that high doses of gluten and early introduction may promote protection against celiac disease.

Only one of four randomized trials investigating possible previously reported connections- PreventCD researchPublished in 2014-Wheat was introduced 6 months before age, and the first daily dose was low (100 mg) in the study. It did not show a reduction in celiac disease compared to placebo.

The recommended minimum daily dose of gluten in the EAT study was about 500 mg per day as early as 4 months of age.

“The suggestion that giving high doses of gluten at a very young age can prevent celiac disease has not really been considered,” Gupta said.

She said the EAT study was conducted as follows: Breakthrough LEAP trialThis shows that early introduction of peanuts significantly reduces peanut allergies at age 5. Based on LEAP findings, US guidelines have changed to recommend early peanut introduction rather than avoidance for children at high risk of peanut allergies.

Main results of EAT Six allergic foods such as peanuts, sesame, eggs, milk, cod and wheat to 1,303 children in the UK, randomized to food introduction from 4 months randomized to 1,303 children Announced in 2016 to cover early introduction of age (early introduction) or full breastfeeding for at least 6 months (standard introduction). The analysis did not show any benefit to the early introduction of food with the intention of processing the analysis, but protocol-specific analysis suggested benefits at high doses.

To further investigate the possible role of wheat introduction dose and timing in the development of celiac disease, a newly published pre-designated analysis was performed containing data from 1,004 study participants.

The average age at the time of introduction in the initial introduction group (EIG) was 4 months (range 4-33 months), while in the standard introduction group (SIG; range 5-21 months) it was 7 months. At 4-5 months, only 2.3% of the children in the SIG group were introduced to gluten, while 69.5% of the children in the EIG group were introduced to gluten.

The average amount of gluten consumed in the first 4 to 6 months of life was 0.49 (SD 1.40) g / wk for SIG and 2.66 (SD 1.85) g / wk for early introduction (!P<0.001).

Weekly average gluten consumption ranged from 0.08 (SD 1.00) g / wk for 4 months to 0.9 (SD 2.05) g / wk for 6 months between controls. The initial introduction was 1.3 (SD 1.54) g / week in 4 months to 4.03 (SD 2.40) g / week in 6 months.

“EAT research [previous] Gluten was introduced at the age of four months and was introduced in larger quantities, which more represents the size of the age-appropriate portion, “the researchers write.[I]Therefore, both early introduction and high doses of gluten may be required to reduce the prevalence of celiac disease in childhood. “

“Our study questioned whether the Prevent CD study would give different results when infants ingested large amounts of gluten, similar to the gluten ingested by families in the observational literature that underpinned the initial introduction hypothesis. It was raised, “says the researchers.

The limitation of the study cited by the researchers was the diagnosis of celiac disease at different treatment centers.

Gupta pointed out that a relatively short time frame for follow-up can also be considered a limitation of the study.

“Food allergies are usually present in young children, but celiac disease may not appear until teens or adults,” she said, adding that a three-year follow-up may not have been sufficient. ..