Absence of toxicity of oats in patients with dermatitis herpetiformis

N Engl J Med. 1997 Dec 25;337(26):1884-7. doi: 10.1056/NEJM199712253372604.


Background: People with gluten sensitivity should avoid foods containing wheat, rye, and barley, but there has been debate about whether they should avoid oats. Although patients with celiac disease have recently been shown to tolerate oats, less is known about the effects of oats on patients with dermatitis herpetiformis.

Methods: We studied seven men and three women (mean age, 58 years) with biopsy-confirmed dermatitis herpetiformis. They had followed a strict gluten-free diet for a mean of 15.8 years, which controlled their rash and enteropathy. The patients added oats that were not contaminated with gluten to their diets for 12 weeks (mean [+/-SD] daily intake, 62.5+/-10.8 g).

Results: None of the patients had any adverse effects. Serologic tests for antigliadin, antireticulin, and antiendomysial antibodies were negative before oats were introduced into the diet and after they were discontinued. Villous architecture remained normal: the mean (+/-SE) ratio of the height of villi to the depth of crypts was 3.59+/-0.11 before the diet and 3.71+/-0.09 afterward (normal, 3 to 5), and the mean enterocyte heights were 31.36+/-0.58 microm and 31.75+/-44 microm, respectively (normal range, 29 to 34). Duodenal intraepithelial lymphocyte counts all remained within normal limits (mean, 13.8+/-1.03 per 100 enterocytes before the diet and 14.2+/-1.2 per 100 enterocytes afterward; normal range, 10 to 30). Dermal IgA showed no significant changes.

Conclusions: Patients with dermatitis herpetiformis can include moderate amounts of oats in their gluten-free diets without deleterious effects to the skin or intestine.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Autoantibodies / blood
  • Avena / adverse effects*
  • Dermatitis Herpetiformis / immunology
  • Dermatitis Herpetiformis / pathology
  • Dermatitis Herpetiformis / physiopathology*
  • Diet
  • Female
  • Glutens / administration & dosage
  • Humans
  • Immunoglobulin A / blood
  • Intestines / pathology
  • Male
  • Middle Aged
  • Skin / immunology


  • Autoantibodies
  • Immunoglobulin A
  • Glutens