A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease

Catassi, Carlo; Fabiani, Elisabetta; Iacono, Giuseppe; DʼAgate, Cinzia; Francavilla, Ruggiero; Biagi, Federico; Volta, Umberto; Accomando, Salvatore; Picarelli, Antonio; Vitis, I. De; Pianelli, Giovanna; Gesuita, Rosaria; Carle, Flavia; Mandolesi, Alessandra; Bearzi, Italo; Fasano, Alessio

doi:10.1093/ajcn/85.1.160

Cited by 465 publications

(327 citation statements)

References 28 publications

(27 reference statements)

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“…Furthermore, assessment of the level of non-adherence at which possible interventions would be deemed to be most beneficial is also problematic, as the potential individual and societal health benefit of small changes in gluten consumption is difficult to estimate. The risk of malignancy, for example, is now believed to be much lower than previously estimated and the influence of occasional non-adherence is unclear (Akobeng & Thomas, 2008;Catassi et al, 2007;Green et al, 2003;Haines, Anderson, & Gibson, 2008;Kaukinen et al, 1999;Silano et al, 2007). Diagnostic delay may have an influence on the likelihood of long term complications beyond treatment adherence (Silano et al, 2007) although the evidence for this is mixed (Haines et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey

2013

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Publisher's copyright statement: NOTICE: this is the author's version of a work that was accepted for publication in Appetite. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be re ected in this document. Changes may have been made to this work since it was submitted for publication. A de nitive version was subsequently published in Appetite, 68, 2013Appetite, 68, , 10.1016Appetite, 68, /j.appet.2013 Additional information: Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. ABSTRACTAdherence to a gluten-free diet is the mainstay of treatment for coeliac disease. Nonadherence is common as the diet is restrictive and can be difficult to follow. This study aimed to determine the rates of intentional and inadvertent non-adherence in adult coeliac disease and to examine the factors associated with both. A self-completion questionnaire was mailed to adult coeliac patients identified from the computer records of 31 family practices within the North East of England. We received 287 responses after one reminder. Intentional gluten consumption was reported by 115 (40%) of respondents. 155 (54%) had made at least one known mistaken lapse over the same period and 82 (29%) reported neither intentional nor mistaken gluten consumption.Using logistic regression analysis, low self-efficacy, perceptions of tolerance to gluten and intention were found to be independently predictive of intentional gluten consumption. A statistical model predicted 71.8% of cases reporting intentional lapses.Intentional non-adherence to the GFD was found to be common but not as frequent as inadvertent lapses. Distinguishing the factors influencing both intentional and inadvertent non-adherence is useful in understanding dietary self-management in coeliac disease.

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Section: Discussionmentioning

confidence: 99%

Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey

2013

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“…3D). Importantly, the hybridomas were most efficiently activated by DQ2.5 homozygous B-LCLs (see EC 50 for the dose-response curves; Fig. 3D).…”

Section: Isolation Of a Murine Cd4 ϩ T Hybridoma Specific For The Immmentioning

confidence: 96%

Resistance to Celiac Disease in Humanized HLA-DR3-DQ2-Transgenic Mice Expressing Specific Anti-Gliadin CD4+ T Cells

Kauwe

Chen

Anderson

et al. 2009

The Journal of Immunology

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Celiac disease is a chronic inflammatory enteropathy caused by cellular immunity to dietary gluten. More than 90% of patients carry HLA-DQ2 encoded by HLA-DQA1*05 and DQB1*02, and gluten-specific CD4+ T cells from intestinal biopsies of these patients are HLA-DQ2-restricted, produce Th1 cytokines and preferentially recognize gluten peptides deamidated by tissue transglutaminase. We generated mice lacking murine MHC class II genes that are transgenic for human CD4 and the autoimmunity and celiac disease-associated HLA-DR3-DQ2 haplotype. Immunization with the α-gliadin 17-mer that incorporates the overlapping DQ2-α-I and DQ2-α-II epitopes immunodominant in human celiac disease generates peptide-specific HLA-DQ2-restricted CD4+ T cells. When exposed to dietary gluten, naive or gliadin-primed mice do not develop pathology. Coincident introduction of dietary gluten and intestinal inflammation resulted in low-penetrance enteropathy and tissue transglutaminase-specific IgA. Two further strains of transgenic mice expressing HLA-DR3-DQ2 and human CD4, one with a NOD background and another TCR transgenic having over 90% of CD4+ T cells specific for the DQ2-α-II epitope with a Th1 phenotype, were also healthy when consuming gluten. These humanized mouse models indicate that gluten ingestion can be tolerated without intestinal pathology even when HLA-DQ2-restricted CD4+ T cell immunity to gluten is established, thereby implicating additional factors in controlling the penetrance of celiac disease.

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“…However, it is difficult to avoid gluten completely. The results of a double-blind placebo control trial established that 10 mg gluten per day is tolerated whereas 50 mg is harmful (Catassi et al 2007), although patients vary in their sensitivity to gluten concentration.…”

mentioning

confidence: 99%

Effect of buckwheat flour on microelements and proteins contents in gluten-free bread

Krupa‐Kozak¹,

Wronkowska²,

Soral‐Śmietana³

2011

Czech J. Food Sci.

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Krupa-Kozak U., Wronkowska M., Soral-Śmietana M. (2011): Effect of buckwheat flour on microelements and proteins contents in gluten-free bread. Czech J. Food Sci., 29: 103-108.Coeliac disease is an autoimmune gluten-sensitive entheropathy. The only available treatment for it is the life-long adherence to a gluten-free diet although these products are often poor in proteins, minerals, and vitamins. The current study was designed to investigate the effect of buckwheat flour incorporation to a gluten-free experimental formulation on the size-related parameters, and microelements and proteins contents. Buckwheat flour affected positively the technological quality of bread, like bread specific volume index and loaf size. Increasing concentration of buckwheat flour (10-40%) in bread affected the proportional enrichment in proteins and microelements, especially in copper and manganese.

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A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease

Cited by 465 publications

References 28 publications

Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey

Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey

Resistance to Celiac Disease in Humanized HLA-DR3-DQ2-Transgenic Mice Expressing Specific Anti-Gliadin CD4+ T Cells

Effect of buckwheat flour on microelements and proteins contents in gluten-free bread

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