Review article: safe amounts of gluten for patients with wheat allergy or coeliac disease
C. HISCHENHUBER,
R. CREVEL,
B. JARRY, M. MÄKI,
D. A. MONERET-VAUTRIN,
A. ROMANO,
R. TRONCONE,
R. WARD,
C. HISCHENHUBER
Nestlé, Nestec Quality Management, Vevey, Switzerland
All authors contributed equally to this study.
Search for more papers by this authorR. CREVEL
Safety & Environmental Assurance Centre, Unilever, Colworth House, Sharnbrook, Bedford, UK
Search for more papers by this authorM. MÄKI
Paediatric Research Centre, University of Tampere Medical School and Tampere University Hospital, Tampere, Finland
Search for more papers by this authorD. A. MONERET-VAUTRIN
Université de Nancy – Hôpital Central, Medicine Interne, Immunologie Clinique et Allergologie, Nancy, France
Search for more papers by this authorA. ROMANO
Università Cattolica del Sacro Cuore C.I. Columbus, Rome and Oasi Maria SS, Troina, Italy
Search for more papers by this authorR. TRONCONE
Department of Paediatrics and European Laboratory for the investigation of food induced diseases, University ‘Federico II’, Naples, Italy
Search for more papers by this authorC. HISCHENHUBER,
R. CREVEL,
B. JARRY, M. MÄKI,
D. A. MONERET-VAUTRIN,
A. ROMANO,
R. TRONCONE,
R. WARD,
C. HISCHENHUBER
Nestlé, Nestec Quality Management, Vevey, Switzerland
All authors contributed equally to this study.
Search for more papers by this authorR. CREVEL
Safety & Environmental Assurance Centre, Unilever, Colworth House, Sharnbrook, Bedford, UK
Search for more papers by this authorM. MÄKI
Paediatric Research Centre, University of Tampere Medical School and Tampere University Hospital, Tampere, Finland
Search for more papers by this authorD. A. MONERET-VAUTRIN
Université de Nancy – Hôpital Central, Medicine Interne, Immunologie Clinique et Allergologie, Nancy, France
Search for more papers by this authorA. ROMANO
Università Cattolica del Sacro Cuore C.I. Columbus, Rome and Oasi Maria SS, Troina, Italy
Search for more papers by this authorR. TRONCONE
Department of Paediatrics and European Laboratory for the investigation of food induced diseases, University ‘Federico II’, Naples, Italy
Search for more papers by this authorILSI Europe, a.i.s.b.l. Avenue E. Mounier 83, Box 6, B-1200 Brussels, Belgium.
E-mail: [email protected]
Summary
For both wheat allergy and coeliac disease the dietary avoidance of wheat and other gluten-containing cereals is the only effective treatment. Estimation of the maximum tolerated amount of gluten for susceptible individuals would support effective management of their disease.
Literature was reviewed to evaluate whether an upper limit for gluten content in food, which would be safe for sufferers from both diseases, could be identified.
When setting gluten limits for coeliac disease sufferers, the overall potential daily intake should be considered, while for wheat allergy limits should be based on single servings. For coeliac disease sufferers this limit should lie between 10 and 100 mg daily intake. For wheat allergy, lowest eliciting doses for children lie in the lower milligram range, while for adults they are most significantly higher.
Gliadins (part of the gluten proteins) not only trigger coeliac disease, but are also major allergens in wheat allergy. Therefore, measurement of gliadins with validated enzyme-linked immunosorbent assay methods provides an appropriate marker for assessing gluten and/or wheat protein contents in food. Available data suggest that a maximum gluten content for ‘gluten-free’ foods could be set, which protects both wheat allergy sufferers and coeliac patients.
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