House CallJune/July 2014 Issue

Research Roundup: Quinoa is OK, Bad Reactions, Refractory Celiac Is Rare & More

The latest medical news for people with allergies and food sensitivities.

Photo of quinoa by antigerasim/istock/thinkstock

Quinoa is OK

Super-nutritious quinoa is a staple for many on the gluten-free diet. A seed (not a grain), quinoa differs biologically from gluten-containing grains (wheat, barley and rye) but there’s been little data describing the gastrointestinal effects of eating quinoa for those with celiac disease.

A study published in January in the American Journal of Gastroenterology determined that quinoa is not harmful. In fact, among study participants, all of whom had celiac, there was a trend toward improved small bowel health after quinoa consumption (about cup daily for six weeks). Eating quinoa also had a mild choles-terol-lowering effect, a heart-healthy benefit.

Bad Reactions

Children with milk or peanut allergies are more likely to experience more severe allergic reactions than kids with other food allergies, according to research presented in March at the annual meeting of the American Academy
of Allergy, Asthma & Immunology. In the study, researchers tracked a group of 126
kids with food allergies for two years.

Just under half of all severe reactions were associated with milk or peanuts. The amount of food eaten—a tiny bite or full serving—didn’t make any difference in the severity of the reaction.

Refractory Celiac Is Rare

When celiac symptoms and intestinal inflammation don’t improve despite strict adherence to the gluten-free diet, one possibility is refractory celiac disease, a challenging condition to manage and one that can carry a high risk of developing T-cell lymphoma.

A study published in February in Alimentary Pharmacology and Therapeutics provides reassuring news that refractory celiac disease is very rare. In Finland, where there’s a high rate of celiac disease, the prevalence of refractory celiac is just 0.31 percent among diagnosed celiacs and only 0.002 percent in the general population. Celiac experts say this data is probably the best estimate of refractory celiac disease available to date.

Pregnancy Diet

Last year, a major study in JAMA Pediatrics found the more nuts moms ate during pregnancy, the lower the risk of nut allergy in their children. Now a study published in February in the Journal of Allergy and Clinical Immunology supports those findings while homing in on the effects of eating other common allergens during pregnancy.
Researchers followed 1,277 mother-child pairs from early pregnancy—a key period of fetal immune system development—to mid-childhood, about age 8. (Mothers weren’t selected to participate in this study based on any other disease.)

Eating peanuts in early pregnancy was associated with a 47 percent reduction in peanut allergy in mid-childhood. Drinking milk in early pregnancy was associated with reduced asthma in mid-childhood and eating wheat in the second trimester was associated with reduced eczema.

Note: Discuss dietary changes during pregnancy with your healthcare professional.

Celiac Screening by Symptoms

Current guidelines focus on symptoms as a key factor in determining which children to screen for celiac disease. Now a large Swedish study published in January in Pediatrics calls that into question. In the study, 12 year olds completed a questionnaire on celiac-related symptoms (e.g., tiredness, stomach- ache, loose stools) and then underwent screening for celiac. The rate of celiac disease was the same in the tweens who reported symptoms and those
who didn’t.

These findings are in line with a recent U.S. study that showed most adults diagnosed with celiac disease after being screened at a community health fair had either atypical symptoms or absolutely no symptoms at all.

Eczema in Allergic Kids

Twenty percent of toddlers with eczema had a food allergy compared to just 4 percent without eczema, according to a large Australian study presented in March at the annual meeting of the American Academy of Allergy, Asthma & Immunology. The risk of food allergy jumped to a whopping 50 percent when eczema developed early in life or was more severe (i.e., required prescription treatment).

Infants and toddlers with eczema may benefit from dietary strategies aimed at reducing the prevalence of food allergy, like exclusive breastfeeding and not delaying the introduction of certain foods once solid food is started. Parents should consult with their pediatrician.

Photo of researcher looking at test tube istock/thinkstock

New Celiac Test

If you’ve adopted the gluten-free diet without formal celiac testing, it can be a miserable undertaking to reintroduce gluten for several weeks (or months) to ensure reliable test results when being screened for celiac disease. Now a new blood test being developed by Australian researchers requires far less gluten consumption for testing to be accurate, according to a preliminary report published in February in Clinical and Experimental Immunology.

After just three days of eating gluten, the test correctly identified the majority of study participants with celiac disease and, importantly, results were negative in all those who didn’t have the autoimmune disorder.

The new test measures the T cell response to gluten. By monitoring changes in these gluten-reactive T cells, researchers say the test could also aid in the development of a therapeutic vaccine for celiac disease. Further studies are needed.
Note: Celiac experts strongly recommend testing for celiac disease before starting the gluten-free diet.

EoE & Food Allergy

Eosinophilic esophagitis (EoE) is an inflammatory condition of the esophagus often triggered by foods like milk, egg, soy and wheat. Most research suggests that EoE is distinct from traditional food allergy.

Recently, a team studying food allergy in EoE discovered that a small group of individuals developed EoE to a food after outgrowing an allergy to that same food. In two cases, patients had normal-appearing biopsies of the esophagus (indicating no EoE) at the time they had a food allergy. After outgrowing the allergy and reintroducing the food to their diet, EoE developed to that food.

Prior food allergy could raise the risk of developing EoE to the same food, researchers concluded. The study was presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology in March.

Senior medical correspondent Christine Boyd lives in Baltimore.

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