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Nutrients 2013, 5(11), 4614-4641; doi:10.3390/nu5114614
Review

The Clinical Response to Gluten Challenge: A Review of the Literature

Received: 4 September 2013; in revised form: 1 November 2013 / Accepted: 6 November 2013 / Published: 19 November 2013
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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Abstract: The aim of this review was to identify, evaluate and summarize all relevant studies reporting on the clinical response to gluten challenge by adult or pediatric patients with suspected or diagnosed coeliac disease (CD) on a gluten-free diet. We evaluated the effect of gluten challenge on changes in symptoms, intestinal mucosa histology, and serum antibodies. A systematic electronic search was performed for studies published as of 1966 using PubMed and Scopus databases. In the reviewed studies, doses ranged from 0.2 to 30 g/day of wheat gluten or comprised a gluten-containing diet. The onset of symptoms upon gluten intake varied largely from days to months and did not parallel serum antibody or histological changes. Within 3 months of gluten challenge, 70%–100% of pediatric CD patients became positive for AGA-IgA and EMA-IgA antibodies and 50%–70% for AGA-IgG. A limited number of trials suggest that no more than half of adult patients developed positive AGA-IgA, EMA-IgA, tTG-IgA or DGP-IgA/IgG titers. Approximately 50%–100% of pediatric and adult patients experienced mucosal relapse of gluten provocation within 3 months, which was preceded by increased mucosal intra-epithelial lymphocytes within several days of challenge. A 3-month high-dose gluten challenge should be suitable to diagnose the majority of CD patients. In some cases prolonged challenge may be needed to verify diagnosis. Combination testing for antibodies and mucosal histology may fasten the diagnosis.
Keywords: gluten challenge; coeliac disease; diagnosis gluten challenge; coeliac disease; diagnosis
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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MDPI and ACS Style

Bruins, M.J. The Clinical Response to Gluten Challenge: A Review of the Literature. Nutrients 2013, 5, 4614-4641.

AMA Style

Bruins MJ. The Clinical Response to Gluten Challenge: A Review of the Literature. Nutrients. 2013; 5(11):4614-4641.

Chicago/Turabian Style

Bruins, Maaike J. 2013. "The Clinical Response to Gluten Challenge: A Review of the Literature." Nutrients 5, no. 11: 4614-4641.



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