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Nutrition for children with chronic diseases and syndromes
Published in Judy More, Infant, Child and Adolescent Nutrition, 2021
Gluten is found in the 3 cereals: wheat, rye and barley. All food and drinks made from these cereals need to be eliminated from the diet of a child with coeliac disease. Some children may need to avoid oats as well as they may be sensitive to a similar protein, avenin, in oats. Sometimes oats are contaminated with traces of wheat, rye or barley.
Relation of Antigliadin Antibodies to Gluten-Sensitive Enteropathy
Published in Tadeusz P. Chorzelski, Ernst H. Beutner, Vijay Kumar, Tadeusz K. Zalewski, Serologic Diagnosis of Celiac Disease, 2020
Wim Th. J. M. Hekkens, Marja van Twist - de Graaf
Berger4 was the first author to report on “precipitins” against cereals, and from this work many have tried to improve the relatively laborious method into a clinically useful and reliable determination. The mere fact that cereal proteins are not toxic to most individuals of the population convinced Berger that an allergic reaction was the basis of the intolerance in patients with celiac disease. He made extracts of wheat, barley, oats, and millet and tested them with the sera of patients with a complement fixation test. He demonstrated antibodies against the first three cereals, but not against millet. He also found that the antibodies against avenin from oats disappeared after introduction of gliadin in the diet. They reappeared after gliadin withdrawal from the diet. Once again he saw evidence for an allergic pathogenesis as he explained his observation as a sensitization reaction against the wheat extracts.
Nutrition as treatment
Published in Geoffrey P. Webb, Nutrition, 2019
Coeliac disease results from a hypersensitivity or allergy to a component of the wheat protein, gluten and similar proteins that are found in barley, rye and some other less well-known cereals. Pure oats do not cause symptoms in most people with coeliac disease unless they have been contaminated with wheat; this is despite the presence of proteins in oats of a protein called avenin which is similar to gluten. The disease is sometimes termed gluten-sensitive enteropathy. The disease is classified as a food allergy because it involves an “abnormal immunological response to food”, but it differs from classical allergy e.g. hay fever and does not involve the production of IgE antibodies. It is an example of the other type of food allergy in which symptoms do not develop until some hours after the ingestion of the offending food and may not reach their peak until 48 h or more after ingestion. This is known as delayed-type hypersensitivity (DTH). Exposure to the allergen leads to sensitization of T-cell lymphocytes and, after sensitization, re-exposure to the antigen causes the sensitized T-cells to release inflammatory mediators and cause a localised inflammatory response. Patients with coeliac disease are also more likely to suffer from other autoimmune diseases like type-1 diabetes, thyroiditis, pernicious anaemia and the chronic skin condition dermatitis herpetiformis: the symptoms of this latter condition respond to a gluten-free diet.
Challenges to drug discovery for celiac disease and approaches to overcome them
Published in Expert Opinion on Drug Discovery, 2019
Luis Vaquero, David Bernardo, Francisco León, Laura Rodríguez-Martín, Begoña Alvarez-Cuenllas, Santiago Vivas
One possibility is the selection of wheat strains with a reduced content of immunogenic epitopes, such as hexaploid strains generated from diploid and tetraploid species more than 1000 years ago. It has been shown that these strains confer immunogenicity and have a lower percentage of α¸ β¸ γ¸ and ω gliadins. Psyllium [70] is an alternative to gluten because it has a minimal effect on the smell and texture of wheat and good cooking properties [71]. Bread made with psyllium is appreciated by both patients with CD and healthy individuals for its texture and flavor. Another alternative is the use of genetic engineering, via RNA interference, to silence genes that encode immunogenic epitopes [72]. Recent studies evaluated the silencing of the HMW-G gene in a transgenic wheat strain (Bobwhite) and found that the content of wet gluten and the period of crop development were decreased. Gene silencing is an alternative to the production of gluten-free products [73]. Other studies have performed genetic modifications in wheat with the deletion of essential gliadin genes. The deletion of the α-gliadin locus on chromosome 6 in a hexaploid strain of wheat (Triticum aestivum) decreased the number of immunogenic epitopes recognized by T-cells, but did not significantly affect the cooking properties [74]. The deleted gliadin genes may need to be replaced with non-immunogenic gliadin or avenin genes to improve dough elasticity. The transgenic wheat strain E82 has been used in patients with non-celiac gluten sensitivity with undetectable immunogenic peptides in feces, and the good tolerability and high acceptance of the bread characteristics of this strain have been presented [75]; this method is pending evaluation in patients with CD to confirm these promising results.