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Gluten Challenge for Accurate Celiac Disease Testing

January 19, 2012

Question:

I’ve been gluten-free for a while and I’m getting tested for celiac disease. How much gluten should I consume before getting the celiac blood panel?

Answer:

As listed in Real Life with Celiac Disease, here are the guidelines for a gluten challenge:

1. Perform basic laboratory testing for IgA-tTG and total IgA level.

2. If tTG is elevated, proceed to step 5.

3. If tTG is within normal limits and there is a history of severe symptoms with gluten exposure, consider HLA-DQ2 or -DQ8 typing. Be cautious with gluten challenge if positive for HLA-DQ2 or –DQ8.

4. If tTG is within normal limits and there is no history of severe symptoms with gluten exposure, proceed begin gluten challenge with one regular cracker or ¼ slice of regular bread. Double this every 1-3 days until significant symptoms develop or until you are eating the equivalent of 4 slices of bread or 2 cups/servings of pasta per day. Continue a full gluten-containing diet for 2 months. Note: The amount and duration of gluten ingestion can be altered depending on the severity of symptoms.

5. Perform endoscopy with duodenal biopsies and check IgA-tTG.

6. If biopsies are negative for celiac disease, continue gluten-containing diet. Recheck tTG in 3-6 months or if symptoms develop. Repeat endoscopy with biopsy if tTG is elevated.

Sincerely,

Melinda Dennis, MS, RD, LDN

References:

Leffler, D. (2010). Chapter 8: Gluten Intolerance: You Mean I Don't Have Celiac Disease? In M. Dennis & D. Leffler. Real Life with Celiac Disease: Troubleshooting and Thriving Gluten Free. (p. 55). Bethesda, MD: AGA Press.

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