Gluten Challenge- What Is It? How Long?

[shelland]

After reading of so many people referring to taking a gluten challenge, I thought it would be easy to Google "gluten challenge" and find a the definition of a gluten challenge. I figured that it would always be the same thing- like a regular gluten challenge would be to go gluten free for a specific amount of time, and then eat a set amount of gluten for another set amount of time and see what happens.

It sounds like this is not so. It seems like there is not a standard challenge.

Can anyone with knowledge of gluten challenges let me know what's up?

[Ursa Major]

It depends on what you want to do. If you just want to know if gluten will indeed make you sick after being gluten-free for a while, a gluten challenge might just be eating one piece of pizza, bread, cake or something else containing gluten, to see if you react. And if you do, you know that gluten is a definite problem and needs to be avoided.

On the other hand, if your doctor wants you to do a gluten challenge for a biopsy, you would have to eat enough gluten to completely destroy your villi again to get a positive biopsy. Which would mean eating the equivalent of at least four slices of bread a day for a minimum of three to six months to even have a slight chance of a positive biopsy (it would often take a year or more). That type of gluten challenge is a terrible idea and could make you deathly ill, not to mention could trigger other autoimmune diseases.

[cruelshoes]

After reading of so many people referring to taking a gluten challenge, I thought it would be easy to Google "gluten challenge" and find a the definition of a gluten challenge. I figured that it would always be the same thing- like a regular gluten challenge would be to go gluten free for a specific amount of time, and then eat a set amount of gluten for another set amount of time and see what happens.

It sounds like this is not so. It seems like there is not a standard challenge.

Can anyone with knowledge of gluten challenges let me know what's up?

From the University of Chicago Celiac Program

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How long do I need to be eating gluten before I am tested for celiac disease?

This is not an easy question to answer. Most people believe, or are told that they need to eat gluten for a few days (or up to a week) before a blood test or a biopsy, and this is incorrect. The true answer depends on how long the individual has been avoiding gluten. How much gluten to eat depends on the age of the individual who is being tested. The information provided here is a general rule, there are many specifics that come into play, so its best to talk with a knowledgable physician about your particular situation.

First: If a patient has avoided gluten for six to 12 months (or more) it is advisable to consider an HLA gene test before a gluten challenge. The HLA gene test will help determine if the patient is even in the risk group for celiac disease. (Only 1/3 of the US population have the genes for celiac disease.) After 6-12 months, it can be difficult to obtain a diagnosis of celiac disease after a gluten challenge, which is why this step is advisable.

Patients who have been on a gluten free diet for less than six months can consider a gluten challenge under a physician's supervision. A challenge would typically require an adult or a child to eat some gluten for four to eight weeks. For some, a twelve week challenge could be required but no challenge should last more than 12 weeks in children. The patient would eat a specified amount of gluten every day.

Many patients are concerned about participating in a challenge. Medical research shows that a limited challenge of this sort provides a greater medical benefit when it leads to a correct diagnosis of celiac disease. The challenge would need to be maintained if a positive antibody test result is received, because the biopsy procedure also depends on the presence of an autoimmune response.

For children, eating a saltine cracker each day would be enough gluten to conduct a challenge and for adults, a slice of bread a day would be adequate. The challenge would need to occur for six to eight weeks before the test in order for it to be accurate. Accordingly, we will not be able to register individuals for the screening who cannot meet this criteria, should they wish to be tested after following the diet.