Intolerance to cereals is not specific for coeliac disease

Background: Abdominal complaints after ingestion of cereals are not uncommo n. We assessed how reliable such a history is as a marker for the presence of overt coeliac disease, and whether we should also take into account late nt coeliac disease and cereal allergy. Methods: The study group comprised 9 3 consecutive adults from health centres spontaneously reporting abdominal symptoms after consumption of cereals. Small bowel mucosal morphology, CD3( +), alpha beta(+) and gamma delta(+) intraepithelial lymphocytes (IELs), HL A DQ alleles and serum IgA-class endomysial (EmA), tissue transglutaminase (tTg) and gliadin (AGA) antibodies were determined. Skin prick and patch te sts and serum radioallergosorbent tests for cereals were carried out. Thirt y non-coeliac adults served as biopsy controls. Results: Eight (9%) patient s had coeliac disease and one mild partial villous atrophy. Altogether 17 h ad an increased density of gamma delta(+) IELs without atrophy. However, on ly seven (8%) showed evidence of latent coeliac disease, i.e. both an incre ase in gamma delta(+) IELs and the presence of coeliac disease-type HLA. On e or more of the allergy tests for cereals was positive in 19; 9 adopted a gluten-free diet and abdominal symptoms were alleviated in all. In non-coel iac patients, serum EmA and tTg tests were negative in all, whereas AGA was seen in 40%. Conclusions: Intolerance to cereals is not a specific sign of overt or latent coeliac disease. All experimental dietary interventions be fore proper diagnosis of coeliac disease are therefore to be discouraged. A llergy to cereals, on the other hand, should be considered even in adults.