A recent randomized double-blind study (MM Leonard et al. Gastroenterol 2021; 160: 720-733. Full Text: Evaluating Responses to Gluten Challenge: A Randomized, Double-Blind, 2-Dose Gluten Challenge Trial) provide evidence that a gluten challenge could detect evidence of celiac disease in hours, not weeks.
This study consisted of 14 adults with biopsy-proven celiac disease (CD) who were randomized to 3 g or 10 g gluten/day intake for 14 days. Each participant underwent extensive studies to detect histological, visible, and biochemical changes associated with gluten introduction. Data required multiple endosopic duodenal biopsies, VCEs and blood collection.
- Symptoms and plasma interleukin-2 levels “increased significantly or near significantly at both doses.”
- Interleukin-2 appeared to be the earliest, most sensitive marker of acute gluten
exposure. IL-2 increases were observed 4 hours after exposure in patients with CD but not in healthy controls.
- Intestinal damage is more complex and requires a longer duration and higher dose of gluten exposure. In this study, the higher dose (10 g) of gluten exposure was required for enteropathy within the study time frame.
My take: These study findings need to be confirmed in a broader patient cohort. However, in patients needing a gluten challenge, IL-2 response after a single-dose (measured at 4 hours) could be helpful. Those without IL-2 response are unlikely to have CD. Those with an IL-2 response at 4 hours, could confirm CD by completing a gluten challenge.
Related blog posts:
- Eliminating Gluten Challenge for Diagnosis of Celiac Diseas
- >99% Accuracy for Non-Biopsy Diagnosis of Celiac Disease
- Followup Biopsies in Pediatric Celiac Disease?
- How Slow Do Objective Markers of Celiac Change After Treatment? | gutsandgrowth
- Are followup biopsies necessary in celiac disease? Look beyond the headlines
- To biopsy or not to biopsy -that is the question (for Celiac disease)
- How Accurate is Serology at Predicting Mucosal Healing in Celiac Disease