Most patients with celiac disease can eliminate their symptoms, but at a price: lifelong adherence to a gluten-free diet. This means no wheat, rye, barley, and, until recently, no oats. Then some recent studies suggested that oats did not cause the intestinal inflammation characteristic of the disease, and thus oats are now often included in the celiac disease diet. This is good news for patients coping with severe restrictions on what they can and must not eat, but a study by Ludvig Sollid and colleagues suggests that oats are not safe for all patients.

Celiac disease is caused by a complex interplay between genetic and environmental factors. Long believed to be a rare disorder, it is now thought to affect about one in 250 people worldwide. Clinical symptoms are present in less than half of patients and vary considerably, but patients with symptomatic disease have a higher risk of developing colon cancer and lymphomas. In individuals with celiac disease, the immune system mounts an abnormal response to gluten, which is characterized by gluten-reactive intestinal T cells and by inflammation and compromised function of the small intestine.

Ludvig Sollid and colleagues studied the response to oats of nine patients with celiac disease. They found that intolerance to oats exists at least in some patients with celiac disease, and that those patients have the same molecular reaction to oats that other patients have to wheat, barley or rye. This strongly suggests that oats are not safe for all patients with celiac disease, but given the small number of patients and the fact that they were not randomly selected, future studies are needed to determine the frequency of oats intolerance.

PLoS Medicine, Oct 18, 2004