Alimentary Pharmacology and Therapeutics. 2006;23(5):559-575
Wheat allergy and coeliac disease are more prevalent than previously thought, and are a significant burden to public health. For both diseases the dietary avoidance of wheat, rye and barley proteins is the only effective treatment.
Estimation of a tolerated amount of gluten for susceptible individuals would support effective management of their disease. Wheat allergy studies in both children and adult populations suggest that eliciting doses of wheat protein are higher for wheat allergy than for coeliac disease – therefore the maximum tolerated dose for coeliac disease patients could also constitute a safe upper limit per serving for wheat allergic patients. Maximum permissible gluten content for “gluten-free” foods could be calculated from the identified maximum tolerated daily dose, permitting establishment of a pertinent international standard for “gluten-free” food that provides dietary variety and optimal protection for at risk wheat allergy sufferers as well as coeliac patients.
Promising progress in ELISA methodology and gliadin reference materials will provide tools for manufacturers and regulatory bodies to effectively verify compliance of such “gluten-free” foods.
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