Can early introduction of gluten reduce risk of celiac disease?

For several years, the common approach to preventing allergic reactions or other food intolerances was to have a child refrain from eating the food until a later time. However, the pendulum has now started to swing the other way with early introduction being an important way to combat allergies and intolerances. An investigation in JAMA Pediatrics looks at whether the same principle works for introducing gluten to reduce the prevalence of celiac disease.¹

The researchers ran an open-label clinical trial, which recruited children from the general population of England and Wales. The infants were randomized to either avoid allergenic foods and follow UK infant feeding recommendations of exclusive breastfeeding until aged roughly 6 months, the standard introduction group, or to consume 6 allergenic foods (peanut, sesame, hen's egg, cow's milk, cod fish, and wheat) in addition to breast milk from age 4 months, the early introduction group.

A total of 1004 infants were included in the study’s analysis. The average quantity of gluten consumed between ages 4 and 6 months was 0.49 (1.40) g/wk in the standard introduction group and 2.66 (1.85) g/wk in the early introduction group (P < .001). The average weekly consumption in the standard introduction group ranged from 0.08 (1.00) g/wk at age 4 months to 0.9 (2.05) g/wk at age 6 months versus 1.3 (1.54) g/wk at age 4 months to 4.03 (2.40) g/wk at age 6 month in the early introduction group. Among the 516 children in the standard introduction group, 7 had confirmed diagnosis of celiac disease. There were no children with a celiac disease diagnosis among the 488 children in the early introduction group (P = .02, risk difference between the groups using the bootstrap, 1.4%; 95% CI, 0.6%-2.6%).

The researchers concluded that introducing gluten at age 4 months was linked to reduced celiac disease prevalence. They believe that the results indicate the early high-dose consumption of gluten could prevent celiac disease and should be considered for future, further studies.

Reference

1. Logan K, Perkins M, Marrs T. Early gluten introduction and celiac disease in the EAT Study: a prespecified analysis of the EAT randomized clinical trial. JAMA Pediatr. September 28, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.2893