Symptomatic suspected gluten exposure is common among patients with coeliac disease on a gluten-free diet

Aliment Pharmacol Ther. 2016 Sep;44(6):612-9. doi: 10.1111/apt.13725. Epub 2016 Jul 22.


Background: A gluten-free diet is the only recommended treatment for coeliac disease.

Aim: To determine the prevalence and characteristics of reactions to gluten among persons with coeliac disease on a gluten-free diet.

Methods: Adults with biopsy proven, newly diagnosed coeliac disease were prospectively enrolled. A survey related to diet adherence and reactions to gluten was completed at study entry and 6 months. The Coeliac Symptom Index, Coeliac Diet Assessment Tool (CDAT) and Gluten-Free Eating Assessment Tool (GF-EAT) were used to measure coeliac disease symptoms and gluten-free diet adherence.

Results: Of the 105 participants, 91% reported gluten exposure <1 per month and median CDAT score was 9 (IQR 8-11), consistent with adequate adherence. A suspected symptomatic reaction to gluten was reported by 66%. Gluten consumption was unsuspected until a reaction occurred (63%) or resulted from problems ordering in a restaurant (29%). The amount of gluten consumed ranged from cross-contact (30%) to a major ingredient (10%). Median time to symptom onset was 1 h (range 10 min to 48 h), and median symptom duration was 24 h (range 1 h to 8 days). Common symptoms included abdominal pain (80%), diarrhoea (52%), fatigue (33%), headache (30%) and irritability (29%).

Conclusions: Reactions to suspected gluten exposure are common among patients with coeliac disease on a gluten-free diet. Eating at restaurants and other peoples' homes remain a risk for unintentional gluten exposure. When following individuals with coeliac disease, clinicians should include questions regarding reactions to gluten as part of their assessment of gluten-free diet adherence.

MeSH terms

  • Adult
  • Celiac Disease / diet therapy*
  • Celiac Disease / epidemiology*
  • Diet, Gluten-Free*
  • Feeding Behavior* / physiology
  • Female
  • Glutens / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Prevalence
  • Restaurants / statistics & numerical data
  • Surveys and Questionnaires


  • Glutens