Im posting this response to the list as this information may not be common knowledge in the celiac community, and perhaps it should be. There are a number of reports, regarding celiac patients, of coexisting intolerance to milk proteins. One recent report was of an investigation for cross reacting antibodies. They found none, but a number of these patients displayed antibodies against gliadin and parallel anticasein antibodies (1). Another group has indicated that 36% to 48% of celiac patients demonstrate antibody reactions to milk proteins (2), although there are some reports that the frequency of such sensitivities reduce with treatment of a gluten-free diet (3), although the latter publication reported a higher initial frequency of reactions to milk proteins. There is another report of one celiac patient thought to have refractory sprue who recovered with the additional dietary exclusion of egg, chicken, and tuna (4). The patient became very ill before the possibility of immune reactions to other dietary proteins was considered. These reports suggest to me that we need to be vigilant about the possibility of additional food sensitivities. Before leaping to the use of steroids, further antibody testing seems prudent. The therapeutic use of systemic steroids carries the potential for some very dangerous side effects. Dietary exclusion of allergenic proteins, on the other hand, is just an inconvenience, one that most of us are already well versed in. ELISA or similar testing ought to be done prior to beginning steroids, as such drugs may be unnecessary, or they may compromise the accuracy of such testing.

Sources:

• Paranos S, et al. Lack of cross-reactivity between casein and gliadin in sera from coeliac disease patients. Int Arch Allergy Immunol. 1998 Oct;117(2):152-4.
• Volta U, et al. Antibodies to dietary antigens in coeliac disease. Scand J Gastroenterol. 1986 Oct;21(8):935-40.
• Scott H, et al. Immune response patterns in coeliac disease. serum antibodies to dietary antigens measured by an enzyme linked immunosorbent assay (ELISA). Clin Exp Immunol. 1984 Jul;57(1):25-32.
• Baker AL, et al. Refractory sprue: recovery after removal of nongluten
• Dietary proteins. Ann Intern Med. 1978 Oct;89(4):505-8.

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