By Deborah Rotenstein, M.D., Pediatric Alliance — Endocrinology Division
“How can I protect my child from developing celiac disease?” The old advice has been to give small amounts of gluten between 4-6 months of age while maintaining breast feeding. Two studies published last week in the New England Journal of Medicine debunk this concept.
In high-risk kids, the timing of gluten introduction does not influence the development of celiac disease in childhood. Also, neither the duration nor maintenance of breast feeding when gluten is introduced influences the risk of celiac disease later in life. The only risk factor for developing celiac disease later in life is genetic — namely the HLA genotype. It is HLA types HLA-DQ2 and HLA-DQ8 that are associated with risk. Since the number of individuals with these necessary HLA types (>25% in the Western world) has not changed there remains no firm explanation for why there is a striking increase in the incidence of celiac disease in recent years. Candidate concepts for increased risk of celiac disease include elective cesarian sections, infections during childhood, antibiotics, and proton pump inhibitors – all of which have very low relative risk. We know very little about “non-celiac gluten sensitivity” and must remember that information on celiac disease cannot be extrapolated to this new and increasingly recognized entity.
So to answer the question – we do not yet know how to protect children from developing celiac disease. Research continues and hopefully we will have some better advice in the future.