title: Even small amounts of gluten cause relapse in children with celiac disease.
abstract: BACKGROUND
  Previously, a gluten challenge was customary to establish the diagnosis of celiac disease in children. There are no clear recommendations on how to perform this challenge or what markers to rely on for timing the biopsy after the challenge. The authors' aim was to monitor gluten intake, clinical symptoms, and antibody kinetics to evaluate the influence of gluten exposure during the challenge.
  
  
  METHODS
  Twenty-five children under investigation for suspected celiac disease were challenged. One child was excluded because blood samples, food records, or biopsy was lacking. Median age at the postchallenge biopsy was 3.8 (2.7-8.8) years. The families kept daily records of the children's gluten intake and of symptoms that occurred. Blood samples were taken monthly for analysis of antigliadin and endomysium antibodies and total immunoglobulin A (IgA). A third biopsy was performed when clinical symptoms suggested a relapse.
  
  
  RESULTS
  All 24 children showed deterioration of the mucosa or elevated antibodies during gluten challenge. Median duration of the challenge was 13 (5-51) weeks, and mean gluten intake was 1.7 (0.2-4.3) g/d and 0.1 (0.02-0.26) g/kg daily.
  
  
  CONCLUSIONS
  Gluten intake during the challenge varied widely, and the parents were unable to give their children the recommended amount. Despite the small amounts given, all children showed signs of relapse at a clinical, laboratory, or histologic level. Much smaller amounts of gluten than previously suggested seem sufficient to cause relapse during gluten challenge in children.
authors.affiliation: Division of Pediatrics, Department of Health and Environment, Faculty of Health Sciences, Linköping University, Linköping, Sweden. pia.laurin@swipnet.se
authors.forename: Pia
authors.initials: P
authors.lastname: Laurin
authors.forename: Mats
authors.initials: M
authors.lastname: Wolving
authors.forename: Karin
authors.initials: K
authors.lastname: Fälth-Magnusson
mesh_terms: D001706:Biopsy; D001835:Body Weight / Q000187:drug effects; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005903:Gliadin / Q000276:immunology; D005983:Glutens / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood / Q000276:immunology*; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D012008:Recurrence; D013997:Time Factors
chemical_list: D007070:Immunoglobulin A; D005983:Glutens; D005903:Gliadin