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Analysis and clinical effects of gluten in coeliac disease

Stern, Martina; Ciclitira, Paul J.b; van Eckert, Renatec; Feighery, Conlethd; Janssen, Frederik W.e; Méndez, Enriquef; Mothes, Thomasg; Troncone, Riccardoh; Wieser, Herberti

European Journal of Gastroenterology & Hepatology: June 2001 - Volume 13 - Issue 6 - p 741-747
Review

The prolamin working group coordinates research on laboratory gluten analysis in food and on clinical evaluation of patient sensitivity to prolamins. As an observer organization to the Codex Alimentarius Commission, the group summarizes current data on analysis and effects of gluten in coeliac disease. All types of gliadin, the ethanol-soluble fraction of gluten, contain the coeliac-active factor. However, coeliac toxicity and immunogenicity (humoral and cellular) of various prolamins are not identical in coeliac patients. There are no conclusive data on the threshold of gluten sensitivity of coeliac patients. Information as to the long-term risk to coeliac patients exposed to small doses of gliadin is lacking. Therefore, every effort should be made to keep the diet of coeliac patients as gluten-free as possible. The prolamin group is currently evaluating a new enzyme-linked immunosorbent assay (ELISA) protocol for gluten analysis that could serve as a basis for further Codex regulations. The group recommends adherence to a single Codex limit for gluten-free foods. The current limit of 200 ppm gluten is questionable and requires reconsideration based on new information that will be available soon.

aUniversity Children's Hospital, Tübingen, Germany, bThe Rayne Institute, St Thomas’ Hospital, London, UK, cTechnical University, Graz, Austria, dUniversity of Dublin, Ireland, eInspectorate of Health Protection, Zutphen, The Netherlands, fCentro Nacional de Biotecnologiá, Madrid, Spain, gDepartment of Clinical Chemistry and Pathobiochemistry, University Hospital, Leipzig, Germany, hUniversity ‘Federico II', Napoli, Italy, and iDeutsche Forschungsanstalt für Lebensmittelchemie, Garching, Germany

Received 26 September 2000

Revised 24 October 2000

Accepted 12 December 2000

Correspondence to Professor Dr Martin Stern, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany Tel: +49 7071 2983781; fax: +49 7071 295477; e-mail: martin.stern@med.uni-tuebingen.de

© 2001 Lippincott Williams & Wilkins, Inc.