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    Oats Intolerance in Celiac Disease

    Reviewed and edited by a celiac disease expert.

    Celiac.com 10/28/2004 – The obvious problem with this study is that it is so small—only nine people. It does, however, bring up valid concerns about the safety of oats for all celiacs. There may exist a sub-set of celiacs who also have avenin-reactive mucosal T-cells, avenin being the oat counterpart to wheats gliadin. It is important to conduct future studies that are designed to determine just how many celiacs also have avenin intolerance.

    Most patients with celiac disease can eliminate their symptoms--at a price: life-long adherence to a gluten-free diet. This means no wheat, rye, barley, and, until recently, no oats. Then some recent studies suggested that oats did not cause the intestinal inflammation characteristic of the disease, and thus oats are now often included in the celiac disease diet. This is good news for patients coping with severe restrictions on what they can and must not eat, but a study by Ludvig Sollid and colleagues in this issue of PLoS Medicine suggests that oats are not safe in all cases.

    Like other chronic inflammatory diseases, celiac disease is caused by a complex interplay between genetic and environmental factors, but it is better understood than most. Long believed to be a relatively rare disorder, it is now thought to affect about one in 250 people worldwide. Clinical symptoms are present in less than half of patients and vary considerably. Genetically, almost all patients have one of two predisposing HLA molecules, which determine the context in which their immune system encounters foreign antigens, including gluten proteins found in wheat and other cereals. In individuals with celiac disease, the immune system mounts an abnormal response to gluten, which is characterized by gluten-reactive intestinal T cells and by inflammation and compromised function of the small intestine.

    Ludvig Sollid and colleagues applied the current understanding of celiac disease and a range of molecular pathology tools to studying the response to oats of nine patients with celiac disease. The nine patients were not a random sample: all of them had been eating oats, and four of them had shown clinical symptoms after oats ingestion. The goal of the study was to characterize the intestinal T cell response to oats in these patients, and to relate it to clinical symptoms and intestinal biopsy results. All patients were on a gluten-free diet and ate oats that were free of contamination by other cereals.

    Three of the four patients who had reported problems after eating oats showed intestinal inflammation typical of celiac disease, and Sollid and colleagues studied intestinal T cells from these three patients. Two of the five patients who seemed to tolerate oats also had oats-reactive intestinal T cells. Functional study of these T cells showed that they were restricted to celiac-disease-associated HLA molecules and that they recognized two peptides derived from oat avenin that are very similar to peptides of gluten.

    Taken together, the findings show that intolerance to oats exists at least in some patients with celiac disease, and that those patients have the same molecular reaction to oats that other patients have to wheat, barley, or rye. However, identical reactions were also seen in two of the patients who were clinically tolerant to oats. The authors suggest that these reactions could develop into symptomatic disease after some time delay, but there is no proof that the presence of oats-reactive T cells is an indicator of future symptoms or even of enhanced susceptibility to clinical oats intolerance.

    Oats are not safe for all patients with celiac disease, but future studies are needed to determine the frequency of oats intolerance.

    Abstract of Study:

    Background
    Celiac disease is a small intestinal inflammatory disorder characterized by malabsorption, nutrient deficiency, and a range of clinical manifestations. It is caused by an inappropriate immune response to dietary gluten and is treated with a gluten-free diet. Recent feeding studies have indicated oats to be safe for celiac disease patients, and oats are now often included in the celiac disease diet. This study aimed to investigate whether oat intolerance exists in celiac disease and to characterize the cells and processes underlying this intolerance.

    Methods and Findings
    We selected for study nine adults with celiac disease who had a history of oats exposure. Four of the patients had clinical symptoms on an oats-containing diet, and three of these four patients had intestinal inflammation typical of celiac disease at the time of oats exposure. We established oats-avenin-specific and -reactive intestinal T-cell lines from these three patients, as well as from two other patients who appeared to tolerate oats. The avenin-reactive T-cell lines recognized avenin peptides in the context of HLA-DQ2. These peptides have sequences rich in proline and glutamine residues closely resembling wheat gluten epitopes. Deamidation (glutamine?glutamic acid conversion) by tissue transglutaminase was involved in the avenin epitope formation.

    Conclusions
    We conclude that some celiac disease patients have avenin-reactive mucosal T-cells that can cause mucosal inflammation. Oat intolerance may be a reason for villous atrophy and inflammation in patients with celiac disease who are eating oats but otherwise are adhering to a strict gluten-free diet. Clinical follow-up of celiac disease patients eating oats is advisable.

    Copyright: © 2004 Public Library of Science.


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    my son has been on a strict diet at home with me , for the last 15 months...gluten, dairy, soy, corn, free...but after returning from his every other weekend dad..he has been ill....even though I know his dad is not as strict as me, with organic, no preservatives etc...yesterday he only had one meal there..ie breakfast...oats....within 2 hrs returning, he was complaining about a headache...fell asleep on the floor...seen this so many times, when he returned...after another 2 hrs sleeping, he awoke complaining about a painful stomach...the meal was gluten free oats....finally...I get the answer!...

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    Yes, I too have a bad allergic reaction to oats, much worse than wheat or rye. Also eat breads without additives and without baking powder and be sure to make sure there is no soy.

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    Good article. I have been gluten free for some time now, but after having an "episode" after breakfast (oatmeal) one day on a recent trip, I was once again trying to figure out why I felt so bad. Then, my wife happen to remember something she read recently about Oats and I did some additional research. Oats are now out of my diet and it appears to be working out - and of course this adds additional food restrictions. There is not a lot of research on this, and as it was suggested in the article, more is needed. Thanks for the info.

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    I ate TRADER JOE'S gluten free oats and broke out with dermatitis herpetiformis type lesions that have persisted for a year after I stopped eating OATS. SO beware of oats. I have had CELIAC disease for over 34 years, people still do not understand the dietary restrictions and make fun of it.

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    Good article. I have been gluten free for some time now, but after having an "episode" after breakfast (oatmeal) one day on a recent trip, I was once again trying to figure out why I felt so bad. Then, my wife happen to remember something she read recently about Oats and I did some additional research. Oats are now out of my diet and it appears to be working out - and of course this adds additional food restrictions. There is not a lot of research on this, and as it was suggested in the article, more is needed. Thanks for the info.

    Just because it is gluten free other proteins mimic gluten i.e. AVENIN IN OATS. BEWARE.

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    Celiac.com's Founder and CEO, Scott was diagnosed with celiac disease  in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. Scott launched the site that later became Celiac.com in 1995 "To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives."  In 1998 he founded The Gluten-Free Mall which he sold in 2014. He is co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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