No "window of opportunity" for celiac disease prevention

December 8, 2014 Uma Pisharody, MD, FAAP

As a pediatric gastroenterologist, I’m often asked whether there is any way to prevent a child from developing celiac disease. Based on what I knew regarding how food allergies develop, I used to counsel families that there might be a “window of opportunity”, between four and six months, when it’s possible to introduce grains and other gluten-containing foods that could potentially “teach” the immune system to tolerate gluten and thus lower the risk of developing celiac disease.

However, my “window theory” recently got thrown out the window when the results of two important scientific studies were published in the New England Journal of Medicine.

The first study involved nearly a thousand infants who were enrolled into an international, multicenter, randomized, double-blind, placebo-controlled dietary intervention. All of the children carried genes that made them susceptible to developing celiac disease and some even had a first-degree relative with the condition. From the age of four to six months, approximately half of these infants were fed gluten while the other half received placebo. When they reached the age of 3 years, there was no significant difference in the number of kids who developed celiac disease between the two groups. The researchers also looked into whether breast-feeding influenced the development of celiac disease, but also found no difference.

The second study, also a randomized trial, involved over 800 Italian children, all of whom had first-degree relatives with celiac disease. As infants, these children were divided into two groups: one group was fed gluten starting at six months of age while the second had gluten introduced at 12 months of age.  The children were tested until they were 10 years old. Results showed that that the risk of developing celiac disease depended more on genes than other factors (not when gluten was introduced into the child’s diet nor whether the infant was breastfed).

Disheartening as these study results may be, it’s important to note that while we may not be able to prevent the development of celiac disease, it is completely treatable with diet alone. With strict adherence to a lifelong gluten-free diet, your child can expect to live a long and healthy life. Also, remember that celiac disease is not the same as food allergy or food sensitivity. It’s an autoimmune disorder triggered in some genetically-predisposed individuals to cause inflammation in their body when they eat gluten. If you’re interested in knowing how to have your child checked for celiac disease, make an appointment with our pediatric gastroenterology team.

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