Celiacs, Dairy Products and ELISA Testing
by Ron Hoggan

Few celiac and DH patients need to be told of the dramatic impact food can have on our wellness. Yet in our preoccupation with gluten we may overlook the importance of other dietary sensitivities. One report of patients with dermatitis herpetiformis indicated that regardless of compliance with a gluten-free diet, a large portion of DH patients continued to demonstrate antibodies against proteins found in cow's milk (1). Another report indicated that about half of untreated celiacs mount an immune response to one or more of the proteins in milk (2).

Since a large majority of treated celiac patients continue to demonstrate increased intestinal permeability (3), and since there are reports of coexisting celiac disease and milk protein intolerance (4), it seems prudent to consider this possibility. It is also important to be watchful for indications of autoimmunity arising out of intolerance to proteins in these additional food groups. One report states: "Adverse reactions to food occur in about 1-2% of the population" (5). One may reasonably expect that such reactions would be more common among celiac patients due to our increased intestinal permeability even after recovery. One report indicates that even after antibody levels against gliadins are normalized among treated celiac patients, there is an increased incidence of antibodies against milk proteins (6).

Of course, latase deficiency is also common in untreated celiac disease, and in the first months after beginning the gluten-free diet, but the incidence of that problem drops to about the same level as the general population after the intestine heals (7).

A new means of testing for antibodies against common foods has been developed. It is called: enzyme-linked immunoassay, but is usually referred to as ELISA (pronounced ee-ly-za) testing. Although it is available in the U.S. I have been unable to locate a lab in Canada that is conducting such testing. It could prove very valuable to celiacs who continue to have problems with celiac-like symptoms despite their best efforts to comply with the g-f diet. Perhaps we can hope to see ELISA testing in Canada soon.

Sources:

1. Barnes RM, Lewis-Jones MS, Isotype distribution and serial levels of antibodies reactive with dietary protein antigens in dermatitis herpetiformis. J Clin Lab Immunol 1989 Oct;30(2):87-91
2. Volta U, Lazzari R, Bianchi FB, Lenzi M, Baldoni AM, Cassani F, Collina A, Pisi E Antibodies to dietary antigens in coeliac disease. Scand J Gastroenterol 1986 Oct;21(8):935-40
3. Lobley RW, Burrows PC, Warwick R, Dawson DJ, Holmes R Simultaneous assessment of intestinal permeability and lactose tolerance with orally administered raffinose, lactose and L-arabinose. Clin Sci (Colch) 1990 Aug;79(2):175-83
4. Fluge G, Aksnes L, Influence of cow's milk proteins and gluten on human duodenal mucosa in organ culture. J Pediatr Gastroenterol Nutr 1990 Nov;11(4):481-8
5. Halvorsen R, Eggesb M, Botten G, [Reactions to food]. [Article in Norwegian] Tidsskr Nor Laegeforen 1995 Dec 10;115(30):3730-3
6. Ciclitira PJ, Ellis HJ, Richards D, Kemeny DM, Gliadin IgG subclass antibodies in patients with coeliac disease. Int Arch Allergy Appl Immunol 1986;80(3):258-61
7. Bode S, Gudmand-Hoyer E, Incidence and clinical significance of lactose malabsorption in adult coeliac disease. Scand J Gastroenterol 1988 May;23(4):484-8