title: Symptomatic suspected gluten exposure is common among patients with coeliac disease on a gluten-free diet.
abstract: A gluten-free diet is the only recommended treatment for coeliac disease.
  
  
  
  To determine the prevalence and characteristics of reactions to gluten among persons with coeliac disease on a gluten-free diet.
  
  
  
  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.
  
  
  
  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%).
  
  
  
  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.
authors.affiliation: College of Medicine, University of Manitoba, Winnipeg, MB, Canada.|Celiac Research Program, Harvard Medical School, Boston, MA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Silvester
authors.affiliation: College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: L A
authors.initials: LA
authors.lastname: Graff
authors.affiliation: St Boniface Hospital, Winnipeg, MB, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Rigaux
authors.affiliation: College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: J R
authors.initials: JR
authors.lastname: Walker
authors.affiliation: College of Medicine, University of Manitoba, Winnipeg, MB, Canada.|St Boniface Hospital, Winnipeg, MB, Canada.
authors.forename: D R
authors.initials: DR
authors.lastname: Duerksen
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000178:diet therapy* / Q000453:epidemiology*; D055050:Diet, Gluten-Free; D005247:Feeding Behavior / Q000502:physiology; D005260:Female; D005983:Glutens / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D015995:Prevalence; D012147:Restaurants / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
chemical_list: D005983:Glutens