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