Allergies & Anaphylaxis – school age
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Melissa Little

Msc RD, Pediatric and Antenatal Dietician. She is a spokesperson for the British Dietetics Association on TV and in print. Member of the parliamentary group for a Fit and Healthy Childhood at Westminster for the UK Government.
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Child care & health

Coeliac disease and other gluten problems in children

Coeliac disease is not an allergy, it is an autoimmune disease. This means the body produces an antibody when gluten enters the digestive system. 1 in every 100 people will develop coeliac disease and the Department of Health recommends not giving any gluten containing food to babies under six months of age.
In Short

Children with coeliac disease can't eat:

Wheat (including most bread, couscous, pasta, foods thickened with wheat flour such as some sausages and bought soups).

Barley (including malt vinegar).

Rye.

Some coeliac children also have to stop eating oats as they produce the antibody to the gluten in oats too.

Coeliac disease in babies and children

Coeliac disease is not an allergy it is an ‘autoimmune disease.’ This means the body produces an antibody when gluten enters the digestive system. 1 in every 100 people will develop the coeliac disease and the Department of Health recommends not giving any gluten containing food to babies under six months of age.

What is gluten?

Gluten is a large protein found in wheat, barley and rye. For this reason, some people may confuse coeliac disease with a wheat allergy or wheat intolerance.

What does the gluten antibody do to make a coeliac person ill?

When the body produces an antibody to gluten it can attack the lining of the gut. The lining of the small intestine is full of finger-like extensions called villi. The villi have a good blood supply allowing nutrients from the food to be transported into the bloodstream to be taken to the liver.

People with long term coeliac disease will have lost a large proportion of the villi in their intestines. It is estimated the surface area of an adult’s healthy gut is the size of a tennis court whereas the surface area of the coeliac gut may only be the size of a dining table.

This destruction of the intestinal lining can lead to serious malnutrition and poor absorption of nutrients.

What are the symptoms of the coeliac disease?
Toddler-on-potty

Inflammation and damage to the small intestine lining can lead to pain, discomfort and problems with growth. This may happen soon after introducing gluten in solids but it might not occur until later in childhood.

Symptoms include the following, but your baby may have coeliac disease without having all these signs or symptoms:

  • Tummy pain.
  • Pale and greasy poo due to poor absorption.
  • Bloated tummy.
  • Vomiting.
  • Wind.
  • Tiredness.
  • Constipation.
  • Reduced growth.
  • Weight loss or lack of weight gain (falling below their weight centile), often easiest to spot around the buttocks.
  • Skin problems such as dry and flaky skin.
  • Dark circles under the eyes.

Your child might be very highly strung and get very sad or angry about minor things. In children with an undiagnosed coeliac disease, they are not getting enough nutrition and will suffer from the symptoms of a ‘blood sugar low’ which can make anyone feel cranky and emotional. They may crave high sugar foods to cope with this.

How is coeliac disease diagnosed?

Coeliac disease can be reliably diagnosed with a blood test which simply counts the levels of the gluten antibody in the blood.

This blood test is highly sensitive but there is some differing of opinion on what to do if a child receives a positive result on the test.

Some doctors will then diagnose coeliac disease on the basis of the antibody results. They will then prescribe a gluten-free diet where gluten is completely excluded from the diet. After gluten has been removed from the diet for a period of time they may retest the blood to confirm that the antibodies are no longer there (this means that the diet is truly gluten-free). They will also look for signs of recovery and if growth improves and symptoms disappear they will recommend a life-long gluten-free diet.

Some doctors will want to confirm a diagnosis by keeping the child eating the gluten for several more months and then will perform a biopsy to see that the gluten has definitely damaged the gut. If the damage is found in the biopsy they will then recommend a life-long gluten-free diet.

The rationale for the blood test diagnosis is that the ‘cure’ of the gluten free diet can begin immediately which can be important for a child that isn’t growing and is suffering.

The rationale for continuing to eat gluten to test for intestinal damage in the future is that cutting out gluten from your child’s diet for life is a big step and you may want to be sure with a diagnostic biopsy.

It is worth speaking to several paediatric gastroenterologists and auto-immune experts to discuss these two options with respect to your child and her specific situations.

What foods does my child need to avoid because they contain gluten?

You will need to remove all foods that contain:

  • Wheat (including most bread, cous cous, pasta, foods thickened with wheat flour such as some sausages and bought soups).
  • Barley (including malt vinegar).
  • Rye.
  • Some coeliac children also have to stop eating oats as they produce the antibody to oat ‘gluten’ too.
What foods can my child still eat on a gluten-free diet?

The good news is that is lots of food you can eat and for most of the human history grains containing gluten have not been a big part of the diet. So you can eat:

  • Meat.
  • Fish.
  • Vegetables.
  • Fruits.
  • Rice.
  • Quinoa.
  • Gluten-free pasta (made with potato and rice flours).
  • Gluten-free bread (made with potato and rice flours).
  • Gluten-free cakes and biscuits (made with potato and rice flours).

Living in the UK with coeliac disease, the good news!

The UK is one of the best countries, in terms of availability of gluten-free food and good food labelling. So:

  • Most supermarkets have good ranges of gluten-free foods that you can confident giving your child.
  • You will also receive a prescription for some safe gluten-free foods each week for your child.
  • Food labels in the UK have to state if they contain gluten or are prepared in a factory where gluten based products are made.
  • National restaurant chains and places like the National Trust are very good at labelling food with gluten in it and making gluten-free options e.g., soup thickened with potato flour or gluten-free/flour-free cakes made with polenta or ground almonds.
Does ‘wheat free’ mean that the food is gluten-free?

No! Wheat-free products may contain other grains, such as rye or barley.

Gluten-free products may contain other wheat proteins so may not be suitable for children who are intolerant or allergic to wheat (as opposed to coeliac disease).

Is there a cure for the coeliac disease?

There is no cure for coeliac disease per se but your child will make a full recovery (including the regrowth of intestinal villi) by following a gluten-free diet. You will quickly see improvements in mood and then growth will start to pick up when the gut is enough recovered (not immediately) to allow good absorption of nutrients.

However, clinical trials for a vaccine for coeliac disease is now underway. The vaccine hopes to prevent damage to the villi in the intestine when a coeliac or celiac eats gluten.

Gluten allergy or sensitivity

An allergic reaction is generally a more systemic response by the body. In extreme cases, a child will go into anaphylaxis when they ingest or touch the food they are allergic too.

This is a true, immediate wheat or gluten allergy is caused by an IgE reaction to one or more of the proteins found in the wheat grain. Wheat contains the following types of protein:

  • Globulins
  • Albumins
  • Glutenins
  • Gliadins

This kind of wheat allergy is actually most common in babies (when they are initially given wheat or grains to eat) and the good news is that it usually goes away within a few years. Symptoms of this kind of wheat allergy (IgE mediated) may include:

  • runny nose
  • asthma
  • hives or an itchy rash
  • swelling under the skin
  • eczema
  • diarrhoea and tummy ache

Here a video with more information about food allergies and how to introduce high allergy foods to your baby:

There is more controversy about not immediate gluten senstivity as it is harder to test for it. Some people report the same symptoms to gluten as coeliacs but it is unclear what the bodies response is as there is no gluten antibody. If your baby does not positive for coeliac disease but seems to have bad symptoms and poor growth speak to your doctor about the pros and cons of trying a gluten-free diet. It is not advisable to cut out a whole food group without getting medical advice or having your baby referred to a dietitian.

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.