Celiac disease and weaning: when is it right to introduce gluten?

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Catherine Le Nevez
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Celiac disease, not to be confused with wheat allergy, is an autoimmune disease caused by a gluten intolerance. For this reason, those with celiac disease must exclude foods that contain it from their diet: we are therefore talking about bread, pasta, biscuits and pizza made with flours containing gluten. 

Regarding weaning, until a few years ago it was believed that delaying the introduction of gluten in the child's diet, at least after the first year of age, could have a sort of protective effect against celiac disease. More recent studies, however, have disproved this theory. We talk about it with the dr. Mauro Calvani, Director of the Pediatric Complex Operational Unit of the San Camillo Hospital of the city and Coordinator of the Commission for Food Allergies of the Del Paesena Society of Pediatric Allergology and Immunology (SIAIP).

In this article

  • intolerance or allergy
  • when to introduce gluten
  • how to introduce gluten
  • celiac disease symptoms
  • diagnosis

Gluten intolerance or wheat allergy?

Let's start immediately by making a bit of clarity because when we talk about celiac disease it is often confused with wheat allergy. However, these are very different pathologies although the treatment can be quite similar.

Celiac disease

"Celiac disease - explains Dr. Calvani - is a permanent intolerance to gluten, more precisely it is a disease mediated by a non-IgE mediated immunological mechanism". In short, celiac disease is due to a reaction of our immune system against gluten, contained in many cereals such as wheat, barley, spelled, rye, etc.

Allergy to wheat

Wheat allergy, on the other hand, is an IgE-mediated allergic reaction caused by wheat protein. It is an allergy more common in children than in adults and can manifest itself with skin reactions, respiratory symptoms or digestive disorders that arise immediately after ingestion of the food, a few minutes, a maximum of hours after the meal.

Read also: Celiac disease children: foods

When to introduce gluten

"It was once thought that delaying the introduction of an allergenic food was beneficial to prevent the development of allergic diseases, such as allergy to wheat, egg, peanuts and this theory had also been applied to celiac disease, although it is a mediated non-IgE allergy (which some define intolerance), therefore not a classic real allergy - explains Dr. Calvani - in reality, however, it was realized that for allergies this strategy is not usefulindeed, sometimes it can have consequences quite the opposite. The later the allergenic food is administered, the greater the risk of developing an allergy, especially in children suffering from dermatitis.

In fact, in recent years, the recommendations of scientific societies regarding the introduction of allergenic foods during weaning have changed radically compared to the past. According to all the latest scientific studies there is no evidence that delay the introduction of allergenic foods after one year of age may affect the risk of developing a food allergy or atopic condition.

A new document from the American Academy of Pediatrics establishes that even foods considered to have a high allergenic risk, including wheat, can be introduced early, that is, during the first year, already at the time of weaning.

Even our Ministry of Health, in the document "When a baby is born", argues that "the order in which semi-solid and solid foods are introduced in the weaning phase no longer holds the importance that was once attributed and can vary in based on the child's preference and the gastronomic culture of the family and the pediatrician who provides the advice ".

We have said, however, that celiac disease is not an allergy, but a permanent intolerance, as we must therefore behave withintroduction of gluten in weaning? "With regard to celiac disease, it was initially realized that, by delaying the introduction of gluten, at most we could delay its appearance in the child, but nowadays thanks to prospective studies we know that regardless of when we introduce gluten into the 'complementary nutrition, the onset of celiac disease cannot be prevented. So much so that the current guidelines affirm the possibility of giving gluten-containing foods even to children considered "at risk" as early as 4 months ", Calvani specifies.

This is also said by the European Society of Gastroenterology, Hepatology and Pediatric Nutrition which explains, in an article published in the Journal of Pediatric and Gastroenterology Nutrition, how the introduction of gluten early (less than 4 months), or late (more than 12 months), does not reduce the likelihood of developing the disease in children at risk (genetic factors).

So let's forget the old weaning schemes that provided for the introduction of allergenic foods only after the year of life and instead go ahead also for gluten-containing meals starting from 4/6 months, always using common sense about the quantities and forms in which food is offered to the child.

Read also: Allergenic foods in children: what they are and how to introduce them in the diet

How to introduce gluten during weaning

"The rule of applies, as for all other foods introduce the food gradually, without exaggerating with the quantity because it was realized that perhaps an excess of gluten could represent a risk factor for some children "explains Dr. Calvani.

Furthermore, the foods offered to the child must always be given in one safe shape for their age to avoid the risk of suffocation.

Read also: Children and the risk of suffocation: 4 tips to prevent

Celiac disease: when to suspect it?

Celiac disease or gluten intolerance can take months or even years to become evident and usually the symptoms are gastrointestinal such as diarrhea and / or vomiting. "Celiac disease affects the intestinal mucosa and if the damage is slight, the symptoms can be nuanced, such as iron deficiency," disordered "intestine, abdominal swelling or no symptoms may appear - explains Calvani - but it is a question of a slow and devious disease because if not diagnosed it can predispose to the onset of tumors and intestinal pathologies. "Hence the need to diagnose it as soon as possible even in children.

Read also: Celiac disease and children: strict diet and annual checks

Celiac disease and wheat allergy: how is the diagnosis made?

Today the diagnosis of the celiac disease it is possible thanks to valid serological tests. "We go to check for the presence of anti-transglutaminase or anti-gliadin antibodies, and if they are found to be very high (over 10 times the normal value) it is not necessary to perform an intestinal biopsy as was done until recently, while for L'wheat allergy we resort to skin tests (Prick Test) or to search for specific IgE "concludes Dr. Calvani, who also and above all insists on the importance of not subjecting children for the diagnosis of allergies and celiac disease to unreliable tests, or rather, do it, and contact the pediatrician, preferably a specialist in pediatric allergology or gastroenterology.

Read also: Children's allergy test: everything you need to know

  • celiac disease
  • weaning and gluten
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