A web-based survey was conducted among over 1,500 patients with either celiac disease (CD) or non-celiac gluten sensitivity (NCGS). It was found that subjects with NCGS were more likely than those with celiac disease to disagree with the following statement: “Vaccines are safe for people with celiac disease” (NCGS 41.3% vs. CD 26.4%), and were more likely to decline vaccinations when they were offered. Compared to those with celiac disease, subjects with NCGS were also more likely to avoid genetically modified foods, eat only organic products, believe that the FDA is an unreliable source of information, and believe that a gluten-free diet improves energy and concentration. According to the authors, their findings suggest that the lack of reliable information on gluten and its content in food and medications may reinforce beliefs—such as avoidance of vaccines—that could have negative effects on public health.
Rabinowitz, L.G., Zylberberg, H.M., Levinovitz, A. et al. Skepticism Regarding Vaccine and Gluten-Free Food Safety Among Patients with Celiac Disease and Non-celiac Gluten Sensitivity.
Dig Dis Sci (2017). https://doi.org/10.1007/s10620-017-4879-1
Respiratory infections and celiac disease
Research continues into environmental factors (in addition to gluten) which may be linked to development of celiac disease. A study published in the journal Pediatrics looked at the potential effect of childhood respiratory infections on future development of celiac disease. These researchers noted that common infections before the onset of autoimmune diseases may be an important factor in conditioning the immune response. 373 genetically pre-disposed newborns who had at least one relative with celiac disease were included in the study. The cumulative incidence of celiac disease in this study group was 6% at 3 years of age, 13.5% at 5 years of age, and 14% before the sixth year of life. An analysis of adverse events found that those diagnosed with celiac disease had experienced a higher frequency of respiratory tract infections during the first two years of life. Researchers concluded that the frequency of respiratory infections in the first two years of life could distinguish children who developed celiac disease from those who did not.
Auricchio R, et al. Respiratory Infections and the Risk of Celiac Disease. Pediatrics, October 2017, Volume 140 / Issue 4. Abstract available online: http://pediatrics.aappublications.org/content/early/2017/09/04/peds.2016-4102
FDA recommendations on labeling gluten in medications
In December, 2017 the Food and Drug Administration (FDA) issued draft guidance regarding labeling of gluten in medications. The document recommends that drug manufacturers that wish to make statements about gluten content use the following statement, when it is truthful and substantiated: “Contains no ingredient made from a gluten-containing grain (wheat, barley, or rye).” According to this draft guidance, such a statement would be interpreted by the FDA to mean that the manufacturer knows that no ingredient in the product was derived directly or indirectly from any gluten-containing grains. In addition, the FDA encourages drug manufacturers to have accurate information about their products’ gluten content available so they can respond to questions from consumers and health care professionals.
Comments on the draft guidance were due on February 12, 2018. GIG is supportive of guidance which would make it easier for gluten-free consumers to determine the gluten-free status of their medications. GIG’s comments on the proposal can be seen here: (link. not yet finalized as of 1/29).
Link to FDA draft guidance: (https://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM588216.pdf )