The April, 1999 Tufts University Medical Letter stated that according to the Food Allergy Network, the following eight foods cause 90 percent of all allergic reactions:

• Peanuts
• Tree nuts (such as almonds, cashews, pecans, and walnuts)
• Fish
• Shellfish
• Eggs
• Milk
• Soy
• Wheat.

A: Have you tried eliminating dairy? Volta et. al. have demonstrated that 36% to 48% of celiacs tested were also intolerant to milk protein. Borner et. al. have demonstrated sequence homology, from the N-terminal, between casein and gliadin. The other three cited below are also identifying milk protein intolerances associated with celiac disease.

Playing the odds, exclusion of dairy is most likely to help. But there are other significant dietary allergens that might be eliminated if a dairy free diet, in addition to the Gluten-free diet, doesnt help.

• Borner H, Isolation of antigens recognized by coeliac disease auto-antibodies and their use in enzyme immunoassay of endomysium and reticulin antibody-positive human sera. Clin Exp Immunol 106(2), 344-350 (1996)

• Hvatum M, Serum IgG subclass antibodies to a variety of food antigens in patients with coeliac disease. Gut 33(5), 632-638 (1992)

• Ciclitira PJ, Gliadin antibody production by small intestinal lymphocytes from patients with coeliac disease.Int Arch Allergy Appl Immunol 89(2-3), 246-249 (1989)

• Volta U, Antibodies to dietary antigens in coeliac disease. Scand J Gastroenterol 21(8), 935-940 (1986)

• Ciclitira PJ, Secretion of gliadin antibody by coeliac jejunal mucosal biopsies cultured in vitro. Clin Exp Immunol 64(1), 119-124 (1986)

Breast milk contains antibodies against all the antigens the mothers immune system has met prior to or during the pregnancy and has produced antibodies to them.

This system is the wisdom of nature and this is the way that mothers milk protects babies from all the antigens (infectious agents, toxins etc.) occurring in the environment where the mother lives. These antigens without this protection may enter the body through the digestive or respiratory systems. The best example is that breast milk protects babies from bacteria causing diarrheas in the underdeveloped countries.

The antibodies are produced by the cells (plasma cells) localized in the gut and the lung. These cells are migrating to the lactating breast-tissue for hormonal trigger (enteromammal plasma cell circle) and they continue producing these antibodies in the breast. These antibodies appear in the breast milk. In brief, the breast milk may contain all the antibodies the mother has in her digestive and respiratory systems. The function of these antibodies is to block the entrance of antigens infectious agents, toxins, allergens etc) across the digestive or respiratory tract of babies.

In case of celiac disease, it means that if the mother has circulating antibodies to gliadin, these antibodies appear in the milk. If the breast fed baby ingests gliadin (or the mother ingests accidentally and traces of gliadin appear in the milk) the antibodies in the milk blocks the gliadin and it will not able to cross the intestinal wall and meet with the babys immunosystem. Theoretically, the breast-fed infant do not have any immunoreaction to gliadin. If the mother accidentally ingests gliadin during breast feeding it is likely that the concentration of antigliadin antibodies become higher in the breast milk.

To answer the question: the antibodies in breast milk are protective and do not "trigger" celiac disease in genetically predisposed babies. There are several data showing that breast-feeding has a protective effect in case of celiac disease. Furthermore, it is well documented that breast-feeding in the first year of life decreases the risk of allergies by 50% in babies whose parents have allergies.

As far as the reaction after weaning concerned: it is also known that babies may have some reaction (loose stool or spit up or discomfort) transiently after introducing a new food, however, this is a temporary symptom and not allergy or immunoreaction to the food. It is likely that their digestive system should accommodate to the new foods.

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.