Question:

Please explain what issues a person diagnosed with “high” celiac disease may experience as a result of inhaled gluten from a cafeteria or where others consume foods with gluten.

From,

Lynn

Answer:

Hi Lynn. Thanks so much for your question. I have to confess that I have never heard the term “high” celiac disease used before.

To answer your question, it is possible for someone with celiac disease to experience symptoms from inhaling gluten, although this would be highly unlikely in a cafeteria setting.

I am aware of at least one article, in The New England Journal of Medicine, reporting nonresponsive celiac disease in two farmers due to inhaled gluten. In both instances, the farmers were feeding cattle a supplemental mixture that contained wheat and barley in an enclosed space on a daily basis. After the farmers started wearing face masks, they had dramatic improvement in their symptoms. Additionally, I have read anecdotal reports of celiac patients experiencing symptoms related to inhaling gluten from flour in a bakery or in a home kitchen setting.

The biggest concern for you when eating out is the possibility of getting “glutened” from cross-contamination or hidden sources of gluten in a cafeteria or other restaurant setting. If you have not seen Triumph Dining’s Gluten-Free Restaurant Guide, I highly recommend it, as the book contains some good tips on safely dining out while on a gluten-free diet. Triumph Dining also provides laminated dining cards you can carry with you. These cards provide information you can share with your server or chef on cross contamination issues, as well as what foods you can and can’t eat on a gluten-free diet.

NFCA also trains restaurants to safely serve gluten-free food through its GREAT Kitchens program. Click here for a list of restaurants that have completed gluten-free training.

In good health,

EA Stewart, MBA, RD

Resources:

• Article on Nonresponsive Celiac Disease Due to Inhaled Gluten from The New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMc063112
• Triumph Dining: http://www.triumphdining.com/
• GREAT Kitchens: www.CeliacLearning.com