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Celiac.com 02/09/2024 - In a push for increased inclusivity, a gluten-intolerant student has garnered overwhelming support for her petition urging McDonald's to offer more gluten-free options in its UK branches. Chloe Radzikowski, a 22-year-old trainee paramedic from Leigh, launched the petition, which highlights the disparity in gluten-free offerings between UK and European outlets of the fast-food giant. So far, the petition has gained over 10,000 signatures. Radzikowski, who developed gluten intolerance last year, expressed her shock and frustration at discovering that McDonald's provided more gluten-free choices in its European locations than in the UK. Speaking to BBC Radio Manchester, she emphasized the challenges faced by those with coeliac disease or gluten intolerance, describing the limited food choices and the anxiety associated with potential illness from unintentional gluten consumption. In the UK, McDonald's offers a handful of gluten-free items, including fries, hash browns, fruit bags, carrot sticks, salads, and some desserts. However, the chain explicitly states that, due to the setup of their kitchens, they cannot guarantee the prevention of cross-contamination, and burgers are notably absent from the list of gluten-free options. Radzikowski's advocacy gained momentum after her discovery of a more extensive gluten-free menu in McDonald's Spanish restaurants during a family holiday to Lanzarote. Her petition emphasizes the need for a broader range of gluten-free choices in the UK, aligning with the diverse dietary requirements of individuals with coeliac disease or gluten intolerance. A McDonald's spokesperson responded to the petition, noting that all UK staff undergo allergen awareness training, emphasizing the importance of preparing customized orders with clear allergen labeling. Despite the existing gluten-free offerings, the petition draws attention to the unmet demand for gluten-free burgers and a more comprehensive menu that accommodates a wider spectrum of dietary needs. The petition has attracted notable support, including an endorsement from reality TV star Megan McKenna. As the number of signatures continues to climb, the movement highlights the growing demand for increased gluten-free options in popular fast-food chains, shedding light on the importance of accessible and diverse food choices for individuals with specific dietary requirements. McDonald's now faces increasing pressure to address these concerns and enhance its gluten-free offerings in the UK. Read more at BBC News

Celiac.com 01/30/2023 - To spot regional differences in celiac disease autoimmunity and overall celiac incidence for children born between 2004 and 2010, a team of researchers with The Environmental Determinants of Diabetes in the Young (TEDDY) recently set out to follow an HLA-risk selected group of celiac patients using a uniform protocol. The team evaluated children from six different regions within Europe and the United States. The research team included Marisa, Stahl MD; Qian, Li PhD; Kristian, Lynch PhD; Sibylle, Koletzko MD, PhD; Pooja, Mehta MD; Loren, Gragert PhD; Jill M, Norris PhD; Carin, Andrén Aronsson PhD; Katri, Lindfors PhD; Kalle, Kurppa MD, PhD; Jorma, Ilonen MD, PhD; Jeffrey, Krischer PhD; Beena, Alkolkar PhD; Annette-G, Ziegler MD; Jorma, Toppari MD, PhD; Marian, Rewers MD, PhD; Daniel, Agardh MD, PhD; William, Hagopian MD, PhD; Edwin, Liu MD; and the TEDDY Study Group. Prospective Study of Nearly 7,000 Patients The team prospectively enrolled from birth nearly seven thousand patients with DQ2.5 and/or DQ8.1 in Georgia, Washington, Colorado, Finland, Germany, and Sweden. They regularly screened the children for tissue transglutaminase antibodies (tTGA), and then assessed them for celiac disease follow-up based on clinical need. The team then estimated population-specific figures by weighting the total study-specific incidence with the population-specific haplogenotype frequencies derived from the sites' ample stem cell registries. Research Findings Individual haplogenotype risks for celiac disease autoimmunity and celiac disease varied by region. In some regions, the overall numbers of celiac disease are high. For example, the team found a celiac incidence of nearly 2.5% by age 10 in Colorado children. Adjusted for HLA, sex, and family history, Colorado children had a 2.5-fold higher risk of celiac disease compared to children in Washington state. Celiac rates by age 10 years were highest for Swedish children, at 3%. Their data show that cumulative incidence of celiac disease varies significantly by region, which indicates variable environmental, genetic, and epigenetic factors even within the United States. Such high regional case numbers supports the use of low threshold for celiac screening, along with more research into the reasons for the region-specific differences in celiac disease case numbers. Read more in the American Journal of Gastroenterology The researchers in this study are variously affiliated with theDigestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; the Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, United States; the Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, United States; the Department of Pediatrics, Dr von Hauner Kinderspital, LMU Klinikum, Munich, Germany; the Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland; the Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA, United States; the Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; the Department of Clinical Sciences, Malmo, Lund University, Malmo, Sweden; the Celiac Disease Research Center, Tampere University and Tampere University Hospital; the Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital; the Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland; the Department of Pediatrics, Turku University Hospital, Turku, Finland; the National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States; the Forschergruppe Diabetes e.V. and Institute of Diabetes Research, Helmholtz Zentrum, Munich, Germany; the Institute of Biomedicine, Centre for Integrative Physiology and Pharmacology, Univeristy of Turku, Turku, Finland; the Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; the Diabetes and Celiac Disease, Lund University, Malmo, Sweden; and the Department of Diabetes, Pacific Northwest Research Institute, Seattle, WA, United States.

Celiac.com 09/05/2017 - Did you know that it's not uncommon for many McDonald's stores in Europe to offer gluten-free buns? If you're lucky enough to find yourself in Europe any time soon, here's a quick list of European countries where you can get Gluten-Free McDonald's Buns. Remember, not every McDonald's location offers gluten-free options, so always check first. Numerous McDonald's restaurants in these countries offer gluten-free bun options: Austria Denmark Finland Hungary Italy Norway Portugal Spain Sweden Switzerland The Netherlands The bigger question is when will they offer gluten-free buns in the USA?

Celiac.com 08/20/2021 - I recently spent two weeks traveling through Austria and Italy. As always, my motto was “Be prepared, but stay flexible.” It was a fabulous trip and I thought you might like to know what I did to make it successful. Plan Ahead: Do an Online Search Before You Leave I knew the cities we planned to visit, so I did an online search for health food stores that stocked gluten-free products. I went to “Google” and then typed in “gluten free products” with the city name. I found many stores and took this list with me, using maps and guide books to determine which stores were closest to our hotel. My research paid off. In Vienna the very next morning we walked to the nearest health food store which was about a mile away from our hotel. I bought enough bread, cookies, cereal, and crackers to last two weeks. We rented a car so I had room for all this food in the trunk, but carting all this food around Europe might not have been practical if I was traveling by train. There were two main brands of gluten-free foods in this Vienna store: Dr. Schaer and 3-Pauly. All of the breads were packaged in aseptic containers, so they didn’t require refrigeration until they were opened. Some of the health food stores in Austria (and Germany) are called Reformhaus and there were some additional products with this name on them. I had brought along heavy duty plastic bags so I could transfer the bread to these bags once I opened the packages. Nights were chilly so I stored the food in the trunk of the car, which was like a refrigerator. While I was in this store, I noticed a hand-written chalkboard message by the bakery. With my limited German, I could translate enough of the words to figure out that one could order fresh-baked loaves of gluten-free bread, ready for next-day pick-up during weekdays. Wow––I was impressed. Later in the trip, I found an excellent Reformhaus health food store in Salzburg, Austria––steps away from Mozart’s birthplace––with a great selection of gluten-free packaged foods. Use Dining Cards in Restaurants I used information from the web site of the Celiac Society of Austria to develop my German (Deutsch) dining card and edited it with the help of my daughter-in-law’s Austrian parents. I used the cards frequently. However, most restaurant workers speak English in the larger cities such as Vienna so we could converse in English about my needs. I already had an Italian Dining Card from my previous trips to Italy, so that proved useful in Italy. This was a terrific source of help and there are also dining cards on the web site as well. The European celiac web sites are not written in English (German in Austria and Italian in Italy) so you will need someone to help you translate them. On the Italian web site, there are gluten-free restaurants listed by city. Stay Flexible and Open to New Adventure One day around lunchtime on our way back to Vienna, we noticed a sign that said “Gasthaus” and followed the road, which went on and on for miles up the mountain, eventually leading to a forest. We both thought “this is either going to be very good or very bad.” As it turned out, we eventually found a lovely Gasthaus at the top of the mountain and we were its only luncheon guests. The owner understood what it meant to avoid gluten and spoke good English. She, like most other persons we met on this trip, was aware of the gluten-free diet. She likened it to an allergy, pronouncing it with a hard, rather than a soft “g” but she understood the importance of avoiding gluten. She served us a wonderful Pumpkin Soup and Pork Roast with Red Cabbage. She proudly gave us a tour of the Austrian Gasthaus, showing us all of the guest rooms and explaining how she came to be a Gasthaus owner. It was fascinating because we had never been behind the scenes in an Austrian Gasthaus. It turned out to be one of the most delightful experiences of our trip. Gluten-Free on the Autobahn Being receptive to pleasant surprises also helped me while driving the Autobahn in Austria’s and the Autostrada in Italy, Europe’s equivalents of the Interstate highways in the U.S. They have gas stations and restaurants along the way that are similar to ours in that they sell coffee, soft drinks, packaged food, and souvenirs. I was amazed to find clearly marked, gluten-free packaged foods at these stops in both Austria and Italy. In fact, I found the best gluten-free bread I’ve ever tasted in one of the Italian truck stops called Auto-Grill or Fini Grill. The bread was manufactured in Milan, Italy by CoPharma and the package bore the name of Giuliani. The package was clearly marked “senza glutine”(without gluten) and also marked “senza latte” (without milk) as well. In Austria, I found clearly marked “gluten-frei” almond cookies that I used to make Tiramisu when I got back home. Memorable Meals One of my favorite questions after a big trip like this is “What was your favorite meal?” Unquestionably, my favorite meal was the roasted goose on our first night in Vienna. We had just arrived in late afternoon and immediately searched for a good restaurant, which wasn’t hard. Vienna is full of excellent restaurants. Most restaurants post their menus outside the front door so we could determine if the dishes seemed appropriate. I had heard about the famous Pumpkin Soup (Austria is known for pumpkin products) and wanted to sample it. Our Viennese waiter spoke excellent English and seemed to understand my dining card so he suggested the Pumpkin Soup, which was absolutely outstanding. And, then he said, “By the way, in addition to our other specials today, we have Roasted Goose with Red Cabbage.” It was simply prepared, but outstanding in flavor. I had to forego the customary huge dumpling that is typically served with this meal because it contains flour, but I was very content with my goose and cabbage. The runner-up meal happened the next night in Vienna. We needed a quick supper since we were headed to a Mozart concert (his 250th birthday in 2006 so there were lots of Mozart events). We found an Austrian restaurant and the only thing that was acceptable for me was the Pumpkin Risotto, which turned out to be absolutely fantastic. Again, the dining card was very useful, but the waiter also spoke English. It was perhaps the best risotto I’ve ever eaten. And, the concert was one of the very best we’ve ever attended. Then, there was the fish in Italy, along the Adriatic Coast. Again, the waiter quickly understood my dining card and recommended the whole fish, which was filleted and roasted to perfection. In fact, I often ordered grilled or roasted fish in many restaurants because it was the safest item on the menu and it was fabulous every time. I didn’t order dessert very often because I seldom found anything that was safe and I never risk eating dessert when I travel unless I’m certain that it is gluten-free. But we found many gluten-free chocolate bars and I had Pamela’s biscotti to dunk in the very strong European espresso, so I never lacked for sweet endings to any meal. Breakfast in Europe Most European hotels include a breakfast buffet of cold meats, cheese, wide selection of cold cereals, breads, pastries, fresh fruit, and yogurt. Everything but the cheese and yogurt was off-limits, so I toasted my special bread (using the white toaster bags I brought along for this purpose) and ate gluten-free cereal I had purchased in Vienna. Sometimes, we could order poached eggs so I did this whenever I could. I hope my experiences help you if you’re planning a trip to Europe. Do your homework, be open to adventure, have fun and be well.

Celiac.com 01/16/2019 - Sales data from the EU show sales of free-from products rising steadily through 2017, in both Western and Eastern Europe. Euromonitor International reveals that total “free-from” food sales in those regions rose 11.7% and 8.7% respectively. Makers of free-from food products have typically targeted consumers suffering from dietary intolerances, and gluten intolerances. Indeed, dairy- and gluten-free foods led the 2017 growth figures, rising about 13% each, according to Euromonitor. Interestingly, though demand for free-from foods is expanding into new markets, Euromonitor’s 2017 data shows that most new consumers of free-from products do not suffer from a medical condition or food intolerance that requires specialized food. Rather, new consumers are overwhelmingly free from food allergies or intolerances. Meanwhile, even though growth in the allergen-free category, in general, stood at an anemic 1.3% in the combined region, the growth rate in the less developed markets of Eastern Europe stood out at 9.2%. Mintel notes that 12% of all UK food product launches in 2015 carried a gluten-free claim, more than double the 2011 rate of 7%. The data show that the public currently perceives free-from foods as generally healthier than their counterparts. This perception of health is a key market driver and has helped push the base of consumers beyond the traditional group of allergy or intolerance sufferers. Along with organics, health and wellness products have recorded the largest overall growth at a global level. However, this reality leaves the free-from food category vulnerable to changes in perception. Indeed, research from Mintel found that more than half of consumers who currently buy free-from products would stop doing so if they thought they were "less healthy" than standard offerings. To solidify and expand their product appeal, look for makers of free-from foods to improve the nutritional profile of their products, reducing sugars, fats, and salt, and to offer more grains, such as amaranth, quinoa, sorghum, buckwheat, millet and teff, among other strategies. Overall, look for new healthier, more nutritious breads, breakfast cereals, and snack bars to fill the shelves as consumers continue their quest for healthier, more nutritious foods. That’s generally good news for free-from consumers who do have food allergies or intolerances. It likely means more nutritious, better tasting, better quality gluten-free, dairy-free and other free-from products in the future. Read the full report at Mintel.com (Paywall).

Celiac.com 10/16/2017 - In Europe many commercially available, nominally gluten-free foods use purified wheat starch as a base, but what's the best way to way to measure the gluten content of gluten-free foods, particularly those based on purified wheat starch? Currently, the only test for gluten quantitation certified by the Food and Agriculture Organization of the United Nations (FAO) is based on the R5 monoclonal antibody (MAB) that recognizes gliadin, but not glutenin. A team of researchers recently set out to determine the best way to measure the gluten content of nominally gluten-free foods, particularly those based on purified wheat starch. The research team included HJ Ellis, U Selvarajah and PJ Ciclitira. They are affiliated with the Department of Gastroenterology, Division of Diabetes and Nutritional Sciences at Kings College London, St Thomas Hospital in London. Celiac disease is treated with a strict Gluten-Free Diet (GFD). Gluten is comprised of gliadin, Low (LMWG) and High (HMWG). To estimate gluten content of gluten-free foods, the R5 works by multiplying the R5 gliadin value by two to yield a gluten value. The research team raised a panel of monoclonal antibodies to celiac disease toxic motifs. They then assessed the gluten content of three wheat starches A, B, & C that are supplied as standards for the Transia gluten quantitation kit, which is based on a MAB to omega-gliadin. They used separate ELISAs to measure gliadin, Low (LMWG) and High Molecular Weight (HMWG) glutenins. They found that the gliadin levels in all three starches were always higher, as measured by one of the antibodies, than the levels measured with the other, and that the ratio between measurements made by the 2 MABs varied from 3.1 to 7.0 fold. The team noted significant differences in glutenin to gliadin ratios for different wheat starches. Based on their results, the team suggests that the best way to measure the gluten content of nominally gluten-free foods, especially those containing purified wheat starch, is to first measure gliadin and glutenin, and to then add the values together. This is because measurement of gliadin alone, followed by multiplication by two to yield a gluten content, appears to be inadequate for measuring total gluten in processed foods. Source: Int J Hepatol Gastroenterol. 2017;3(1): 046-049.

Celiac.com 10/12/2017 - Despite the economic downturn, the cost of healthy products has not diminished. Sales have continued to grow in this sector thanks to the many information campaigns aimed at raising consumer awareness of the health benefits of consuming gluten free products. Manufacturers have responded to the growing demand by expanding the variety of products they offer. Many consumers, including those that cannot eat gluten, do not want to give up eating products specially designed for them although they cost even more than traditional food. The demand for products that address food intolerance continues to grow. In Poland, the number of people who are on special diets because of their health problems and food allergies is still growing. More and more people suffer from intolerance to different nutrients. This creates market conditions that encourage developing products that are safe for this group of consumers. Demand, among one sub-set of this market - gluten-free products, is growing among many consumers. Even manufacturers of standard food products have entered this market segment because they see a large and growing potential. The gluten-free food market is growing steadily. The causes, in addition to the increasing number of diagnosed patients, is an increasing awareness among doctors and patients. Celiac disease affects not just children. Currently 60% of diagnosed cases are adults, of which 15-20% are over 60 years of age. Coeliac disease is diagnosed in Europe in 1:200 and in 1:250 people in the U.S. Approximately 70% of those diagnosed are women. Celiac disease is a non-allergic food hypersensitivity, which is caused by a genetic intolerance to gluten, a protein found in cereals such as wheat, rye, and barley. It is estimated that celiac disease affects around 1 percent of the population and this number is likely to grow in the future. In some European countries, patients with celiac disease form more than 2 percent of population. Yet, the most developed market for gluten-free foods is in the United States. The number of newly introduced gluten-free packaged foods and beverages in the U.S. increased by 80% from 2005 to 2010. This trend is expected to continue through the years 2011-2014. Market analysis suggests that gluten-free food sales will grow at least until 2014. Companies producing food should therefore take advantage of the growing trend of food consumption in this category. Traditional gluten-free products such as bread, biscuits, crackers, cereals and pasta products are still in the development stage. In their group, in recent years, producers have continued to introduce new choices. However, we have also seen many innovations among the products in categories such as snacks, dairy products, sauces, spices, desserts and confectionery. Some of these products may already be free from gluten. However, to attract consumers they are now being labeled as gluten-free products. In the United States between 2008-2010 about 300 products in the category of gluten-free snacks were introduced. The U.S. achieved the highest number and value of sales in 2010. In Poland, only some of the really sick people are the diagnosed cases. Associations of people with celiac disease, such as the Polish Association of people with celiac disease and gluten-free diet is trying to raise public awareness of more aspects of the disease. This is another factor that will lead to increased demand for gluten-free foods. Such activities are already producing effects in the West, where preventive information campaigns have been widely carried out. The current emergence, in the Polish market, of western gluten-free food manufacturers and their products, demonstrates both the development of this branch of the food industry and growing awareness among people in other parts of Europe and the USA. For now, Polish brands dominate in our home market. This is due to lower prices compared to imported products. The quality of Polish products is also competitive. The current political situation allows distribution within the country and also for export. Competitive prices offered by Polish companies may be attractive for residents of other countries. Entering into foreign markets, managers should also take into account local eating habits and preferences. For foreign companies it is harder to attract customers, not only because of the price difference, but also because of the taste and form of food. Eating habits are also a strong factor, which influences customers' purchasing choices. So this factor must be included in designing process and entering new markets. Invariably, the problem of much higher priced gluten-free products arises. Gluten-free products are generally much more expensive than wheat-based products. This is due to less demand for them and the continuing refinement of this kind of food, which, so far, offers an inferior taste. A survey conducted by the Gluten-Intolerance Group of North America, estimates that people buying gluten free products spend about 30% of their monthly expenditures on food. This is still a big barrier to overcome for gluten-free food producers. The difference stems from the fact that the materials are non-standard and not as widely available as conventional ingredients. The development of new production technologies also generates additional costs. Furthermore, innovative products will be subjected to laboratory tests. Still, domestic products are cheaper by significant margins compared to products from abroad. Gluten-free food is specially marked by the manufacturers. The characteristic feature is the sign of the crossed head of grain, which indicates that product contains less than 20 ppm of gluten, which corresponds to 20 mg per 1 kg. Use of clear and legible labels will encourage customers to choose these products. The symbol tells the customer what to expect from the product. He can quickly and easily identify what he needs. Many leading companies monitor development of this branch of the food industry. They emphasize packaging and eye-catching labels. They also consider opening separate production lines to produce only this kind of products. Even companies not currently engaged in production of gluten-free food are starting to invest in development of these technologies. Much depends on the purpose of a producer who has to remember that gluten free food is a specialized product. If its purpose is mass production, entry into the gluten-free market may not produce the desired financial results. On the other hand, the advantage, in this case, is the extended offering of products at more competitive prices, which makes the products more attractive in the eyes of customers. At the same time, retailers will appreciate manufacturers that offer a wider choice of products. Financial planning should take into account the above factors and consider investing in new technologies. Access to the widest choice of gluten-free products is the best at Internet stores or health food stores. Supermarkets are not able to provide as wide a choice as the online stores. Potential clients are not just city dwellers who have easy access to health food stores. A package ordered from an online store reaches into every area of the country, and they are open at all hours and on all days. These store types are worth keeping in mind as they pose increasing competition. However, from a price perspective, they cannot compete with supermarkets. The demand for gluten-free foods is growing from year to year, among other reasons, because it also fits with the current trend of preventive health care. The gluten-free food market is characterized by outstanding performance over many years. Even during the recession in 2009, it grew by 11% in global sales (calculated on the basis of USD 2009 exchange rate), compared to the more sedate level of 3% for products in the category of health and wellness. In 2004-2009, gluten-free products reached a 15% annual growth rate (data Euromonitor). In 2009, global sales reached $ 2.3 billion for gluten-free products which represents 27% of food sales from food intolerance groups. Half of those sales were generated by bread, traditionally the most important category. According to Euromonitor analysis, a wide media campaign about celiac disease symptoms such as fatigue, weight gain, skin rashes and lack of concentration, also increased its sales in this category, turning gluten into the "enemy" of good health. As of today, many of the gluten-free product buyers are people who have not been diagnosed with the disease, and who consider themselves to be people sensitive to gluten. They believe that eating gluten-free products improves their health. According to Euromonitor analyses, retail markets around the world, are not only responding to this trend, but also actively helping to increase growth in sales by offering a number of gluten-free products. Researches predict that the market for gluten-free foods will continue to grow over the next five years, although at a slower pace. Forecasts predict that the U.S. market of gluten-free foods and beverages in 2015 will reach sales of $ 5.5 billion.

Celiac.com 05/27/2011 - Refractory Celiac Disease (RCD) is exactly what it sounds like: persistent malabsorption symptoms and intestinal villous atrophy even after following a gluten free diet. It is divided into two subtypes. RCDI has normal intraepithelial lymphocytes (IELs) while RCDII has abnormal IELs. RCDII is by far the more severe - there is no effective treatment, and it is often fatal within five years. Recent studies in Amsterdam and Paris have reported that RCDII can account for 28-75% of RCD patients. A group of researchers led by Ciaran Kelly at the Celiac Center at Beth Israel Deaconess Medical Center in Boston, the only specialized celiac center in New England, set out to determine if the same was true in the United States. They found a much lower incidence, 17%, of RCD patients with RCDII. An editorial by Malamut and Cellier accompanying Kelly's report in the American Journal of Gastroenterology suggests a number of factors that could account for the difference. Primary among them is the different methodology used to diagnose RCDII. In the US study only one method, immunohistochemistry, was used to ascertain whether the IELs were normal or not; in Europe they used three independent experimental techniques to confirm this data. The American researchers note that if they had in fact underdiagnosed RCDII they should have seen more severe cases of RCDI, and they did not. Malamut and Cellier point out that the Boston study may also have overdiagnosed RCDI by examining biopsy samples done only six months after institution of a gluten free diet, when villous atrophy may not have completely healed. An inflated number of RCDI cases would generate an erroneously low percentage of RCDII cases. But the Americans note that only four of the thirty-four cases of RCD they examined were from patients who had been on a gluten free diet for less than a year. Alternatively, the relative dearth of RCDII cases in the US as compared to Europe could be attributed to the different genetic backgrounds of the populations involved - the "melting pot" present in the US rather than the older stocks that may be in Europe. It has been reported that RCDII correlates with HLA-DQ2 homozygosity, and in fact, the HLA-DQ8 allele was found to be more common in celiac patients in New York than in those in Paris. It is also possible that an environmental factor, such as the amount or type of gluten consumed before diagnosis, could account for the discrepancy, but this remains to be investigated. Therapeutic options for the aggressive RCDII are still severely limited; research into it should certainly continue, on both continents. Sources: Roshan et al. The Incidence and Clinical Spectrum of Refractory Celiac Disease in a North American Referral Center. The American Journal of Gastroenterology 2011; 106: 923-928. Malamut and Cellier. Is Refractory Celiac Disease More Severe in Old Europe? The American Journal of Gastroenterology 2011; 106: 929-932.

Celiac.com 04/08/2011 - A medical research team recently conducted an epidemiological review of celiac disease in Iran. The team included M. Rostami Nejad, K. Rostami, M. H. Emami, M. R. Zali, and R. Malekzadeh. They are associated variously with the Research Institute for Gastroenterology and Liver Diseases at Shahid Beheshti University of Medical Science, with the Digestive Disease Research Center,Tehran University of Medical Sciences, both in Tehran, Iran, with the Poursina Hakim Research Institute (PHRI), Isfahan University of MedicalSciences (IUMS), Isfahan, Iran, and with the School of Medicine, University of Birmingham, United Kingdom. Celiac disease has been traditionally believed to be a chronic enteropathy, almost exclusively affecting people of European origin. The use of new, simple, very sensitive and specific serological tests has revealed shown that celiac disease is as common in Middle Eastern countries as in Europe, Australia and New Zealand, where wheat is a major dietary staple. Celiac disease was presumed to be rare in Iran because of low awareness and a low index of suspicion. However new epidemiological data show that celiac disease is a common disorder in Middle Eastern countries, particularly Iran. In fact, studies have shown Iran to have high rates of celiac disease, in both the general population and the at-risk groups, i.e. patients with type 1 diabetes or irritable bowel syndrome (IBS). In developing countries, doing blood tests on at-risk groups is necessary for early identification of celiac patients. Clinical studies show that patients in the middle east present with non-specific symptoms or a lack of symptoms as often as in Europe. Since wheat is a major component of the Iranian diet and exposure to wheat proteins induces some degree of immune tolerance, leading to milder symptoms that may be mistaken with other GI disorders. Getting patients on a gluten free diet is a major challenge for both patients and clinicians in Iran, mainly because commercial gluten-free products are simply not available. Since it is possible that there is some variable frequency celiac disease in different parts of Iran, as is the case for India, the study team suggests the need for a more uniformly designed evaluation of celiac disease for the entire country, a mapping of HLA DQ in the same areas, together with a gluten consumption assessment. Celiac disease rates are quite low in some areas of Iran, such as Shiraz Province, while a summary of the reviewed studies suggests a prevalence of 1% in the remaining areas of Iran, a rate similar to that found in Western European countries. SOURCE: Middle East Journal of Digestive Diseases/ Vol.3/ No.1/ March 2011