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    What is a Gluten Challenge and How Long Must it Last?

    Reviewed and edited by a celiac disease expert.

    A Three Month Gluten Challenge May be Necessary, and the Length Can Differ Between Kids and Adults.

    What is a Gluten Challenge and How Long Must it Last? - A gluten challenge can be daunting to those with symptoms. Image: CC BY 2.0--2017 Canada Summer Games
    Caption: A gluten challenge can be daunting to those with symptoms. Image: CC BY 2.0--2017 Canada Summer Games

    Celiac.com 06/04/2020 - Currently, in order to properly diagnose celiac disease based on serology and duodenal histology, doctors need patients to be on gluten-containing diets, even if they are causing symptoms, and this is called a "gluten challenge." This is a problem for many people, especially those who have already given up gluten, and see benefits from the gluten-free diet. For those people, going back on gluten for several weeks can be demoralizing. For many, it's a deal breaker. This can present challenges for doctors attempting to diagnose celiac disease.

    According to the University of Chicago Celiac Disease Center, a gluten challenge should be done as follows:

    • Eat gluten prior to celiac disease blood tests: The amount and length of time can vary, but is somewhere between 2 slices of wheat bread daily for 6-8 weeks and 1/2 slice of wheat bread or 1 wheat cracker for 12 weeks 12 weeks;
    • Eat gluten prior to the endoscopic biopsy procedure: 2 slices of wheat bread daily for at least 2 weeks;

    A Three Month Gluten Challenge May be Necessary, and the Length Can Differ Between Kids and Adults

    Celiac.com Sponsor (A12):
    In a 2013 study by Maaike J. Bruins, of the DSM Biotechnology Center, The Netherlands, found that:

    Quote

    The onset of symptoms upon gluten intake varied largely from days to months and did not parallel serum antibody or histological changes. Within 3 months of gluten challenge, 70%–100% of pediatric CD patients became positive for AGA-IgA and EMA-IgA antibodies and 50%–70% for AGA-IgG. A limited number of trials suggest that no more than half of adult patients developed positive AGA-IgA, EMA-IgA, tTG-IgA or DGP-IgA/IgG titers. Approximately 50%–100% of pediatric and adult patients experienced mucosal relapse of gluten provocation within 3 months, which was preceded by increased mucosal intra-epithelial lymphocytes within several days of challenge. A 3-month high-dose gluten challenge should be suitable to diagnose the majority of CD patients. In some cases prolonged challenge may be needed to verify diagnosis. Combination testing for antibodies and mucosal histology may fasten the diagnosis.

    Future Tests May Spot Celiac Disease Without Prolonged Gluten Consumption

    Research on systemic cytokine release that occurs after gluten sensitive individuals ingest gluten may lead to new tests that can spot celiac disease without gluten consumption, however, until further research is done, and such tests are developed and made available, a gluten challenge will be necessary to make a formal celiac disease diagnosis.

     



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    Deb888

    I am new to this, but already after three days of no gluten I feel better so much better I can’t believe it. I had the test on Friday and I will get the results, but I guarantee you that I will not do the gluten challenge. I will not subject myself to that illness again. Two nights ago we went to a restaurant and I ate what I thought was a gluten-free meal. I was so sick sicker than I had ever been before. I went three days without gluten so it seemed like my body became even more sensitive to it. I am in Canada, so I’m not sure what the protocol is. I got the test back for my blood and everything is normal but the coeliac test has to be sent away and I won’t get that for three or four days but I am positive that is the problem. I haven’t felt this good in three years and this is after five days of no gluten and recovering from a gluten incident. 

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    trents

    Welcome to the forum, @Deb888!

    There is also the possibility that you do not have celiac disease but are gluten sensitive (NCGS or Non Celiac Gluten Sensitivity). They share many of the same GI symptoms but NCGS is 10x more common. There are no tests for it. Celiac disease must first be ruled out.

    Before the blood draw, had you already begun to reduce your gluten intake?

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  • About Me

    Scott Adams

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


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