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May 18, 2005

Infant Gluten and Celiac Disease: Too Early, Too Late, Too Much, Too Many Questions

Author Affiliations

Author Affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.

JAMA. 2005;293(19):2410-2412. doi:10.1001/jama.293.19.2410

Celiac disease or gluten-sensitive enteropathy has emerged as a common health problem, with an estimated prevalence of 1% in North America and Western Europe.1,2 Although the etiology is not fully understood, celiac disease is considered to be an autoimmune-type disease with tissue transglutaminase (tTG) suggested as a major autoantigen.3 It is triggered in individuals who carry either HLA-DQ2 or HLA-DQ8 genes by the presence in the diet of wheat gluten and similar proteins from rye and barley. However, the fact that only a few genetically susceptible individuals develop celiac disease, even though virtually all individuals are exposed to gluten, has long suggested that the etiology of celiac disease is multifactorial and that other genetic and environmental factors play a role in disease risk and also influence its broad clinical heterogeneity.