Celiac Disease Symptoms and Gluten-Free Diet Information

Why Gluten Free

Why Gluten Free

What Is The Gluten Free Diet And What You Need To Know Before You Try It. You may have heard the term gluten free, and you may even have a general idea as to what it means to eat a gluten free diet. Most people believe this type of diet is a curse for those who simply cannot tolerate the protein known as gluten, as they will never be able to eat any food that contains wheat, rye, barley, malts, or triticale.

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Gluten Free Insider Secrets

Obtain Much Higher Levels of Energy That Help You Live A More Satisfying Life doing more of what you love leads to a much happier life. Discover How To Lose Weight and Decrease Your Waist Size you can lose weight when implementing gluten-free diet but there are those who complain of actually gaining weight. This is often due to a lack of knowledge about which gluten-free foods to eat (more on this later). Discover the Secrets of Gluten-Free Food Preparation That Actually Taste Great and Dont Leave You Feel Like Youre Missing Out this is the one area where people fear the most. There is so much hype about how bad gluten free foods taste. It just doesnt coincide with the facts. Release the Hotter Version of Yourself That You Have Always Wanted To Be when you are overall healthier, youre attitude about yourself changes for the better. Save serious money when shopping for gluten free foods you can lose weight and not spend a fortune doing it. Feel wonderful about yourself by losing weight and get back into that bikini have the body youve always dreamed about and youll be the envy of your friends and getting your self esteem back in the process. Overcome the frustrations regarding gluten free food preparation you no longer have to fear preparing your own foods as you will have the confidence to do it yourself. Discover fabulous tasting foods that will never make you feel like youre missing out you can enjoy your diet and not feel like you are on a diet. Gain control of your life by choosing foods that trigger increases in energy levels youll be able to spend more quality time with your family and friends and wont feel dragged out. They wont be able to keep up with you! Learn about some shockingly surprising places that gluten can be found youll become better able to control what goes in your body by knowing about these hidden time bombs.

Gluten Free Insider Secrets Summary


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Felicity's Gluten Free Diet Handbook

Here's just some of what you're about to learn when reading the gluten free diet handbook: The interesting history of gluten free diet sensitivity in humans. We are not designed to eat wheat! It is something we have learned to digest quite recently in our evolution and not everyone can correctly process gluten. Why gluten actually makes you sick, and why its becoming more common. What is gluten ? When you hear about what gluten does inside our body and how the internal organs cope with wheat you will finally understand where the pains come from and how you can prevent cramps or even treat them as they happen. Celiac disease and its link to gluten intolerance. Celiac disease is now wide spread through society and it is actually increasing with each generation! That means the problem is increasing and your family is at risk more than you or your parents are. Awesome alternatives to bread. Yes, you can still eat fresh bread! When I learned I had to remove bread from my gluten free diet plan, it made me pretty sad because I love sandwiches so much. Eventually I learned a few safe alternatives and now I have toast and sandwiches whenever I want to. Tips for reading food and drink labels to ensure you don't consume gluten. Now this is so important, because food companies will hide gluten in their warnings or actually call ingredients by a name that doesn't even mention gluten. You absolutely must know these so that you can take control of your diet. Read more...

Felicitys Gluten Free Diet Handbook Summary

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Glutensensitive enteropathy

Gluten-sensitive enteropathy or coeliac disease is a malabsorption syndrome due to lymphocyte-mediated hypersensitivity to storage proteins found in wheat and some other cereals. The most important of these is gliadin. Exclusion of gluten-containing foods (wheat, barley, rye and oats) from the diet leads to improvement in symptoms. Tolerance does not develop and avoidance is lifelong. Gluten-free products should be prescribed for patients suffering from this disease (Table 5.8). Table 5.8 Some wheat- and gluten-free products available on prescription and over the counter Gluten-free bread and rolls Glutafin Gluten-free fibre or white mix Juvela Gluten-free harvest mix Glutano Crackers, gluten-free biscuits Glutafin Wheat and gluten-free pasta Schar Wheat and gluten-free pasta Glutano Wheat and gluten-free pasta

Coeliac disease

Coeliac disease deserves a special mention. When discussing this lifelong condition, it is essential that it is not confused with classic food allergy. Allergic reactions usually occur within seconds or minutes of contact with the offending food, or occasionally within hours, whereas coeliac disease rarely causes such an acute, immediate reaction. This is an important distinction, because there is a danger that food companies may place gluten traces in the same danger category as nut traces, with the result that they fall to the temptation of adopting 'may contain' labels. There have certainly been cases where a trace of gluten makes a coeliac unwell, but such cases are not fatal. The symptoms of coeliac disease are very specific. In babies they consist of pale, foul-smelling stools, wind, bloating and poor growth. These symptoms usually develop a few weeks after cereals are introduced into the diet. In those cases where coeliac disease begins as an adult, the symptoms are diarrhoea,...

Gastrointestinal biopsy

Gluten-sensitive enteropathy (coeliac disease) should be diagnosed with serial small bowel biopsies (duodenum or jejunum), demonstrating typical histo-pathological abnormalities on a normal diet and resolution following a gluten-free diet.6 It has been argued that as this diagnosis has such significant lifelong dietary implications, it should then be followed by a further biopsy demonstrating relapse upon a gluten challenge. Few clinicians carry out this third biopsy.

Enteropathyassociated Tcell Lymphoma

EATL is the common form of T-cell lymphoma that occurs as a sequela of celiac sprue. T-cell lymphomas not associated with celiac disease have been reported, but are exceedingly rare (66). Although celiac disease is relatively common in Western countries, EATL is somewhat rare. EATL develops when intra-epithelial T-cells undergo malignant transformation, leading to a monoclonal T-cell population. A spectrum of disease from this monoclonal T-cell population can result (67). Refractory sprue is a condition characterized by celiac disease symptoms that fail to respond to a gluten-free diet (68). Ulcerative enteritis (or jejunitis) is a condition in which ulcerations form in the small bowel which do not improve on a gluten-free diet (69). Lastly, EATL can develop. Patients often have a long history of abdominal pain and weight loss, but interestingly, at least half do not have a prior known history of celiac disease (70). However, as T-cell lymphomas are quite rare without underlying...

Intussusception Introduction

Intussusception is a telescoping of one section of the bowel into another section which results in obstruction to passage of the intestinal contents and inflammation and decreased blood flow to the parts of the intestinal walls that are pressing against one another. If left untreated, eventual necrosis, perforation, and peritonitis occurs. It occurs in infants most commonly between 3 to 12 months of age or in children 12 to 24 months of age. The actual cause is unknown but risk for the condition increased in children with Meckel's diverticulum, celiac disease, cystic fibrosis, diarrhea, or constipation. Surgical correction is indicated if the obstruction of the involved segment cannot be reduced manually or by hydrostatic pressure or if bowel becomes necrotic.

Description Medical Red Blood Cell Disorders

The most common causes of IDA are menstrual blood loss and the increased iron requirements of pregnancy. Pathological bleeding, particularly gastrointestinal (GI) bleeding, is a common cause of iron depletion in men. Iron malabsorption can lead to IDA. Pathological causes include GI ulcers, hiatal hernias, malabsorption syndromes such as celiac disease, chronic diverticulosis, varices, and tumors. Other causes include surgeries such as partial gastrectomy and the use of prosthetic heart valves or vena cava filters.

Gastroduodenal Dysfunction The Gastroparesis Syndrome

Endoneurial Blood Flow

Another possible connection between diabetes mellitus and the GI tract can be infrequent autoimmune disease associated with type 1 diabetes mellitus, such as celiac disease, autoimmune chronic pancreatitis, and autoimmune gastropathy (2). Indeed, about 15-20 of patients with type 1 diabetes mellitus exhibit parietal cell antibodies (26), but on the other hand no clear-cut relationship has been found between parietal cell antibody titers and delayed gastric emptying (26). Finally, the finding of gastroparesis associated with autonomic neuropathy in a diabetic should not preclude the possibility of coexistent mechanical factors contributing to the apparent motor abnormality (27). First assessing the possibility of mechanical obstruction remains a key premise to diagnosing a gut motor disorder under any circumstances.

Food Intolerance and Allergy

Mast Cell Diagram

Non-IgE-mediated primary food sensitivities are usually manifested by 6- to 24-h delayed hypersensitivity reactions following ingestion of food material. The allergic reactions develop slowly and peak at 48 h, subsiding 72 to 96 h later. Mounting evidence suggests that the allergic response involves the interaction between specific allergens from the food and sensitized, tissue-bound T cells, releasing inflammatory mediators. Celiac disease or celiac sprue is an example of a non-IgE-mediated immunological primary food sensitivity. Celiac disease sufferers are sensitive to glutens, particularly the gliadin fraction of wheat and related crops. Gliadin is a simple protein found in the gluten, consisting of 43 glutamine. Following ingestion of glutens, the absorptive epithelial cells in the small intestine become damaged by an inflammatory process. The intestinal damage results in a severe malabsorption syndrome, i.e., diarrhea, bloating, weight loss, anemia, fatigue, and muscle and bone...

The legal background labelling

The European Commission has already recognised the need for transparent labelling by requiring that any starches or modified starches which contain wheat gluten are declared as such. Thus a potato starch can be described as starch or modified starch, but wheat starch must be described as wheat starch or modified wheat starch. Many retailers in the UK, together with some manufacturers, are anticipating the needs of their customers by voluntarily providing information about potential allergens in their product. This may be by providing a full breakdown of compound ingredients, by highlighting the presence of potential allergens or by making specific claims such as 'gluten free' on the product. Inevitably the law is slow to respond to the needs of consumers, and this kind of initiative can provide a useful means of communicating helpful information.

Testing For Autoimmune Diseases

I mentioned in Chapter 3 that people with type 1 diabetes are at risk for other autoimmune diseases, especially thyroid disease and celiac disease. In celiac disease, eating foods containing gluten (that is, those derived from wheat, oats, rye, and barley) cause an autoimmune damage to the wall of the small bowel. This damage leads to diarrhea, abdominal pain, tiredness, problems absorbing vitamins such as vitamin B12, poor weight gain, and decreased growth. It can also affect the absorption of carbohydrates, causing hypoglycemia. The treatment is a gluten-free diet. Screening for celiac disease is done when a diagnosis of type 1 diabetes is made, and then again if the child has problems such as growth failure or weight loss or gastrointestinal problems. The blood test that is done is called tissue transglutaminase IgA autoantibody. If the blood test is positive, then your child will need to see a gastroenterologist, who may do a small bowel biopsy to confirm the diagnosis. You need...

Other international databanks 651 South Africa

The South African Food Intolerance Databank (FIDB) was initiated in 1990 by the Grocery Manufacturers Association in South Africa, which modelled the databank on the UK system. In 1995, the Association for Dietitians in South Africa (ADSA) took over responsibility for the project and subsequently produced The South African Free From Handbook of Food Products, a single book listing free-from information in tabular form. The project was supported by a large number of institutions in South Africa, including the Department of Health, Food Legislation Advisory Group, Consumer Services Board and two coeliac groups. Originally, access to the book had been restricted to medical professionals only, and, although the book was largely distributed by dietitians, it was later made available to the general public through bookshops. The databank covered ten ingredients and additives milk, lactose, egg, soya, wheat, rye and gluten, benzoates, sulphur dioxide, BHA and BHT, glutamates and tartrazine....

Sources of further information and advice 691 Consumers

Coeliac Society gluten-free lists The UK Coeliac Society has been providing information and advice to its members for many years. The Society compiles its own 'List of Gluten-Free Manufactured Products' annually and this is available from its head office in High Wycombe.

Gastrointestinal reactions

Diarrhoeal reactions to foods are common. Isolated gastrointestinal symptoms are a rare manifestation of allergy20,21 but are a common feature of intolerance reactions. Wheat is a common cause of diarrhoeal reactions and benign wheat intolerance must be distinguished from coeliac disease. In coeliac disease a different class of antibodies (IgA, not IgE) is generated.

Heat treatment and cooking

As a general rule heat decreases the allergenicity of proteins, and heat in the presence of moisture even more so, but this biological activity is rarely removed. Allergenicity of whole wheat flour or purified gluten is only reduced and not eliminated by heating up to 120oC for up to one hour (Varjonen et al. 1996, Sutton et al. 1982). Heating rice glutelin and globulin fractions also reduces IgE binding ability by 40-70 (Shibasaki et al. 1979), but the food remains allergenic. Peanut and nut allergens are resistant to heating and even roasting.

Types of foods available

In gluten-induced enteropathy a specific protein (gluten) is responsible for stimulating the immune reaction. Foods have been prepared without gluten, that are suitable for these individuals. When a protein is denatured by heat, most of the original tertiary structure is lost, so that many of the sites recognised by antibodies on the native molecule are destroyed. There are many examples of allergenicity being reduced, but not eliminated, by heating. Thermal processing can be part of a procedure for making hypoallergenic food, but will rarely be sufficient on its own.

Animal Toxins and Plant Toxicants

Overall, healthy individuals can tolerate naturally occurring toxicants. However, there are several conditions under which natural toxicants can create problems. Inborn errors of metabolism or certain drug interactions can make individuals prone to problems caused by natural toxicants. Whereas nutrients can be beneficial to most, they can be deleterious to some, e.g., consumption of lactose by lactose-intolerant people. Other examples include individuals with celiac sprue, sucrase deficiency, fructose intolerance, galactosemia, and phenylketonuria. Individuals taking drugs that inhibit monoamine oxidase enzymes can be affected when eating cheeses or drinking wines, which are high in tyramine. Individuals with sensitivities due to allergies can be affected by foods. Hypersensitivity to a particular substance produces anaphylactic shock. Examples of foods that cause allergies include milk, wheat, nuts, citrus, strawberries, fish (shellfish), and egg. Some individuals have bizarre food...

European countries that successfully set up new databanks

Greece was the first partner of the project to set up its food intolerance databank, in August 1996. The databank is run by the Technological Educational Institution (TEI) of Thessaloniki and covers eight food additives and ingredients milk, egg, gluten, wheat, soya, sulphur dioxide, benzoates and azo colours. The databank is updated annually and currently they have approximately 400 products listed from 25 companies. The Technical University of Graz (Erzherzog Johann Universitat) established the Austrian Food Intolerance Databank in October 1996 with the financial assistance of the Austrian Ministry of Science. This databank covers 11 ingredients and additives milk protein, lactose, peanut, soya, wheat, gluten, egg, fish, benzoate, sulphur dioxide, and azo colours. The databank now has 19 contributors, with a total of 1600 products entered.

Common food allergies

Coeliac disease also has geographical variations. Although formerly thought to be a disease associated with north-west Europeans, including the countries of their migration, chiefly the USA, an equivalent prevalence is being reported in other European countries (Greco et al. 1989). It appears to be uncommon

Other nonIgE antibodies

The diagnosis of gluten-sensitive enteropathy (coeliac disease) is an exception. The detection of specific non-IgE antibodies aids the diagnosis of coeliac disease. Gastrointestinal auto-antibodies of the IgA class (anti-reticulin and anti-endomyseal antibodies) are raised in this condition. They are classed weakly, moderately and strongly positive. Moderately and strongly positive levels of the antibodies are both sensitive and specific when assessed against challenges of gluten coupled with intestinal biopsy (see later).6

On Line Instrumentation

After the measurement the sample is returned to the line by the piston and a fresh sample taken. It is suggested that this has several advantages, notably the compactness of the spectrometer and the minimal changes required to the production line (drilling a hole in the bottom). No side streaming is required. The procedure is particularly suitable for dry products. It is possible to build standard reference samples into the piston which can be measured as the piston rises falls so that temperature drifts and other extraneous problems are greatly alleviated. The one sided system they describe suffers from the disadvantage that only a small volume of the product is sampled and that it is always taken from the same area of the production line. The authors estimate that the cost of a sensor is of order 30-50,000 (1991) and that the payback period in a large gluten drying plant could be of order 1 year.

The role of the dietitian

The dietitian should give an explanation and provide a list of packaged foods that might contain the food to be excluded. Replacements should be suggested, such as an alternative cereal or meat. For example, in patients with wheat or gluten intolerance, the dietician would advise on the availability of wheat- or gluten-free bread and other products. A list of food free from the food allergen is very helpful. Patients should be told how to read labels (such as 'E' numbers) and what to look for when buying packaged foods or eating in a restaurant.

Collaboration with governments

As a journalist, I have been taught to be suspicious of good intentions voiced by politicians, but Soames and his officials proved true to their word. Improvements in food labelling and in public awareness are there for all to see. That initial, fruitful meeting led to further talks with MAFF officials and industry representatives, a liaison that has continued through to the present day. More recently, support groups such as the Anaphylaxis Campaign and the Coeliac Society have provided high-quality input, through MAFF's consultative process, into the Codex Committee on Food Labelling, the international organisation that sets worldwide standards. During a long, laborious process, Codex agreed a list of foods known to cause hypersensitivity which should always be labelled, including peanuts, tree nuts, egg, milk, fish, shellfish, soya and gluten. In its very own sphere, far different from that of anaphylaxis, the Coeliac Society has been quietly active in keeping the needs of people...


Native to the Middle East and domesticated in the sixth millennium b.c., barley is quite possibly the oldest cultivated cereal in the world. A staple in the eastern Mediterranean, it spread to France and Germany via Spain, and reached Britain around 5000 b.c. In antiquity it was used to make porridge, unleavened bread, and beer. Containing less gluten than wheat, barley produces leavened bread that is coarser, darker, and denser than wheat bread. In medieval Europe, which preferred wheat and rye to barley, barley bread was eaten by the poor and used by the rich as trencher bread instead of plates. Barley water was popular as a potion for the sick. In those parts of Europe where much ale and beer were consumed, barley production sometimes exceeded wheat production. Physicians considered barley an inferior foodstuff that caused wind and that cooled and moistened the body. It was the latter two qualities that made barley water an ideal antidote to fevers.

Functional Quality

The ability to make leavened bread from wheat flour depends largely on the unusual properties of the gliadin and glutenin proteins, which together constitute gluten these properties are not shared by the prolamins of barley and wheat, although they are related structurally to the gluten proteins (Shewry, 1995, 1998 Miflin et al., 1999). Gluten storage proteins form a continuous network in dough, conferring the viscoelastic properties necessary to entrap carbon dioxide released during the proofing of leavened bread. The protein network also provides the cohesiveness required for other foods for example, high elasticity is required for making noodles and pasta, while more extensible doughs are needed for making cakes and biscuits (cookies). The quality of wheat is determined by genetic and environmental factors, with poor quality generally resulting from low gluten elasticity (Shewry, 1998 Shewry et al., 2000). Wheat gluten is a complex mixture of proteins with over 50 individual...

Without CC

Children with cystic fibrosis, gastroenteritis, polyps, lymphosarcoma, and celiac disease are particularly susceptible. Intussusception is classified according to the portion of the bowel involved. The most common location for intussusception is at or near the ileocecal valve, but intussusception can occur in both the small and the large bowels.


When diabetic diarrhoea is complicated by faecal incontinence, the first priority is to bring the diarrhoea under control and, subsequently, ascertain whether the patient has a treatable cause for incontinence. Certain conditions that occur with increased frequency in patients with diabetes, including coeliac disease, pancreatic insufficiency, and bacterial overgrowth of the small intestine, must be excluded. Coeliac disease in particular is easily overlooked and can be excluded by taking jejunal biopsies. Pancreatic insufficiency must be considered and should be excluded by measurement of faecal fat and appropriate pancreatic function tests, or by a trial of oral pancreatic enzyme therapy. Bacterial overgrowth can be diagnosed by a hydrogen breath test or suspected by improvement of the diarrhoea by a short course of broad-spectrum antibiotics (ampicillin, tetracycline). Other causes of diarrhoea that must be excluded are irritable bowel syndrome, laxative abuse, rectal prolapse, and...


The diagnosis of chronic diabetic diarrhea is essentially one of exclusion. A major problem with this approach remains that some of the main conditions in the differential diagnosis (pancreatic insufficiency, bacterial overgrowth, celiac sprue) can themselves be part of the diabetic diarrhea syndrome. A careful history should be taken to exclude osmotic diarrhea from excessive ingestion of nonabsorbable hexitols (e.g., sorbitol). A 48-72-hour stool collection for weight and fat measurement used to be standard approach, but it is cumbersome and nowadays tends to be bypassed in favor of other tests, as listed in Table 2. Therapeutic trials with antibiotics, gluten-free diet, pancreatic enzyme supplements Celiac disease might be associated with diabetes and accompanied by features of more severe malabsorption (considerable steatorrhea, hypoalbuminemia, anemia, abnormal Schilling and xylose test, low serum folate) than is characteristic of diabetic diarrhea. Serological tests for celiac...

Upstream Processing

In industrial processes, the cheapest substrates are used to keep the production costs low. Some of the cheap substrates available include barley, barley malt, blood meal, cane molasses, corn gluten meal, corn meal, corn steep liquor, cotton seed meal, dried distillers' solubles, fish solubles, fishmeal, linseed meal, meat meal, bone meal, oat flour, peanut meal, rice bran, rice flour, soybean meal, wheat flour, whey powder, and yeast hydrolysate (87). The composition of the medium has to reflect the demands necessary for the growth and synthesis of products other than cells. The carbon to nitrogen ratio has been found to be a good indicator for studying the optimum requirements for growth and product formation (88). Generally, media consist of an aqueous solution containing dissolved nutrient salts and a gaseous component (O2). The different nutrient sources commonly used in fermentation media are shown in Table 3.3.


A general examination of all the major systems of a patient normally supplements the clinician's history taking. In the case of paediatric examination, in particular, it should include the measurement of parameters of growth -height, weight and head circumference - which should be recorded on an appropriate centile chart. Chronic illnesses such as coeliac disease and poorly controlled asthma may result in a thin, short child, as do the use of long-term high-dose steroids.

European view

Within the European Union various Member States are beginning to address the issue of labelling of allergens with various degrees of official recommendations. In France, the authorities have published a detailed review of the situation and recommended a number of ways in which industry, collectively, can significantly improve the information given to consumers. A restricted list of allergens is covered but the principal focus is on peanuts and similar derivatives, coupled with clearly defined changes to the legal framework for labelling. In Sweden, labelling legislation requires ingredients known to cause intolerance to be stated in the list of ingredients. Examples quoted include eggs, milk, gluten-containing grains, and legumes such as soyabeans, peas and peanuts. The

The Coeliac Society

The Coeliac Society was founded in 1968 as a national support group for people with coeliac disease and dermatitis herpetiformis. Coeliac disease is a lifelong inflammatory condition of the intestinal tract which affects the small intestine in genetically susceptible individuals. This is caused by gluten, a protein in wheat, and similar proteins in rye, barley and oats. As well as information leaflets, the society publishes an annual booklet listing 10 000 gluten-free manufactured foods with updates provided throughout the year.


When reading different texts in this area, it becomes evident that in the medical and scientific community, there is no single global consensus on what is food allergy and what is food intolerance. For example, there are authorities who consider coeliac disease as a type of food allergy and others who regard it as a form of food intolerance. Some may not consider it as either. Indeed, it appears that it all depends on what definition one has used. The terminology which appears to have gained credibility amongst many peers is that adopted by the European Academy of Allergology and Clinical Immunology (EAACI).1 The distinguishing feature of this terminology is that it is based on mechanisms rather than clinical symptoms. The structure of this terminology is outlined in Fig. 1.1. Broadly, adverse reactions are divided into toxic and non-toxic reactions.

Active packaging

Although absorbing oxygen and moisture or emitting carbon dioxide in a package can affect the growth of microorganisms, there are packaging schemes that are specifically designed to inhibit foodborne microorganisms. These fall mainly into two categories, packaging materials and edible films coatings that contain antimicrobial agents that interfere with microbial growth on the surface of the food (Cha and Chinnan, 2004). A variety of antimicrobials can be incorporated into packaging material or applied to the interior surface of the material, ranging from weak organic acids such as acetic, benzoic, lactic, propionic, and sorbic acids enzymes such as lysozyme bacteriocins such as nisin or pediocin triclosan chitosan and fungicides. The selection depends on the target organism and the food. Many of these same agents can be incorporated into edible coatings made from polysaccharides such as starch, cellulose, or gums. Proteins films are based on corn, soy, milk, collagen, and gluten while...

Infant intervention

In the study of an atopic population, eczema and a history of food allergy were reduced at the age of one year in the group fed solids after six months of age compared with those with solids introduced at three months. No food challenges or skinprick IgE testing were performed in the first year, but at five years there was no difference between skin testing to fish, milk and wheat, history of food allergy and eczema between the two groups (Kajosaari 1991). A randomised, population-based study in Finland showed no difference in the cumulative incidence of fish and citrus allergy at three years old between children with fish introduced early or late (after one year old) into the diet, although the children with earlier introduction reacted earlier in life (Saarinen and Kajosaari 1980). Similar observations have been reported with coeliac disease. The later introduction of gluten into the infant diet has altered the age of onset and type of clinical presentation of coeliac disease...