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Introducing high doses of gluten from four months of age into infants’ diets could prevent them from developing celiac disease, a study has found.

These results from the Enquiring About Tolerance (EAT) Study, published today in JAMA Pediatrics, by researchers from King’s College London, Guy’s and St Thomas’ NHS Foundation Trust, St George’s, University of London, and Benaroya Research Institute at Virginia Mason, Seattle, suggest the early introduction of high-dose gluten may be an effective prevention strategy for the disease, though researchers say further studies are needed before being applied in practice.

Celiac disease is an autoimmune disease whereby eating gluten causes the body’s immune system to attack its own tissues. There are currently no strategies to prevent celiac disease and treatment involves long-term exclusion of gluten from the diet. Even very small amounts of gluten in the diet of those with celiac disease can cause damage to the lining of the gut, prevent proper absorption of food and result in symptoms including bloating, vomiting, diarrhoea, constipation, and tiredness.

Previous studies exploring early introduction of gluten in infants have varied in the amount of gluten consumed and the timing of the introduction. The EAT study investigated the effects of gluten alongside breastfeeding, from the age of four months. The results were compared to children who avoided allergenic foods and consumed only breast milk until age six months as per UK government guidelines.

Infants in the intervention arm of the EAT study were given 4g of wheat protein a week from four months of age. This was in the form of two wheat-based cereal biscuits such as Weetabix, representing an age-appropriate portion of wheat.

1004 children were tested for antitransglutanimase antibodies, an indicator of celiac disease, at three years of age. Those with raised antibody levels were referred for further testing by a specialist.  

The results showed that among children who delayed gluten introduction until after six months of age, the prevalence of celiac disease at three years of age was higher than expected – 1.4% of this group of 516 children. In contrast, among the 488 children who introduced gluten from four months of age, there were no cases of celiac disease.

Lead author Professor Gideon Lack, Professor of Paediatric Allergy at King’s College London and head of the children’s allergy service at Evelina London Children’s Hospital said: "This is the first study that provides evidence that early introduction of significant amounts of wheat into a baby's diet before six months of age may prevent the development of celiac disease.  Early introduction of relevant antigens may also have implications for other autoimmune diseases such as type 1 diabetes."

Author Dr Kirsty Logan, Researcher in Paediatric Allergy at King’s College London said: "Early introduction of gluten and its role in the prevention of celiac disease should be explored further, using the results of the EAT Study as the basis for larger clinical trials to definitively answer this question."

ABOUT BENAROYA RESEARCH INSTITUTE

Benaroya Research Institute at Virginia Mason (BRI) works to advance the science that will predict, prevent, reverse and cure diseases of the immune system. BRI is committed to eliminating autoimmune diseases such as type 1 diabetes, rheumatoid arthritis, inflammatory bowel disease and multiple sclerosis, as well as immune system diseases such as allergies, asthma and COVID-19. An internationally recognized medical research institute, BRI accelerates discovery through laboratory breakthroughs in immunology that are then translated to clinical therapies. A leader of collaborative initiatives such as the Immune Tolerance Network and Type 1 Diabetes TrialNet, BRI frequently partners with global research institutes, pharmaceutical and biotech companies. Visit BenaroyaResearch.org or follow BRI’s Autoimmune Life Blog, Facebook, Instagram, LinkedIn or Twitter to learn more.