There is currently no cure for celiac disease or for food allergies. This means that the only truly effective way to avoid reactions and attacks is to avoid the allergen. Making sure your child never encounters gluten if he has a wheat allergy or celiac is difficult because gluten is found in so many foods, and cross-contamination is always possible.
Because of the daily challenges this poses for kids and their families, researchers have tried to answer the question of whether there is a low, safe amount of gluten that a child with celiac disease or a wheat allergy can tolerate. It is also important to understand if any amount can be tolerated because the gluten-free label on foods does not mean that it has zero gluten.
Celiac Disease and Gluten
Celiac disease is not a food allergy, but there are a lot of similarities. Gluten is a protein found in wheat, barley and rye. When someone with celiac disease eats gluten, the immune system attacks the small intestine. This leads to uncomfortable gastrointestinal symptoms like bloating, gas, diarrhea, constipation and vomiting. The only way to avoid reactions is to avoid gluten, and some people suffer the symptoms more severely than others.
In a review of several studies, researchers were able to find a reasonable amount of daily gluten intake for most people with celiac disease. They found that a range of 10 to 100 milligrams of gluten per day is tolerated and does not cause many symptoms. Most importantly, consuming amounts of gluten in this range does not seem to cause long-term effects seen in people who have had undiagnosed celiac disease. These include vitamin deficiencies, osteoporosis and other complications.
Another review found that the amount of gluten tolerated by people with celiac disease varies a lot by individual. Some may be able to eat up to 100 milligrams per day, while others experience symptoms if they eat that much. This review did find that 10 milligrams or less didn’t present a problem for the vast majority of individuals. Although rare, some people with celiac disease cannot tolerate event trace amounts of gluten and can have life-threatening reactions to it.
The Gluten-Free Label
The U.S. Food and Drug Administration (FDA) regulates many of the claims put on food labels, including gluten-free. Currently the FDA requires that anything labeled as gluten-free contain no more than 20 parts per million of gluten. This measurement is equivalent to 20 milligrams of gluten per about 35 ounces of food. For a typical slice of gluten-free bread, this amounts to about a half a milligram of gluten, which is not much considering the findings about how much most people can tolerate.
Wheat Allergy and Gluten
Gluten can trigger reactions in people allergic to wheat, but so can other proteins in wheat. In the review discussed above, researchers concluded that the tolerable limit of gluten for people with celiac disease could also be reasonably applied to most people with a wheat allergy. This may be controversial, though. If you have a child with a food allergy, and you know that life-threatening anaphylaxis is possible, the last thing you want is for him to get even a trace of wheat in his food.
The research does suggest that for most children with a wheat allergy, it takes a few milligrams at least to trigger a reaction. For adults, those who didn’t outgrow their wheat allergy, the base line for a reaction is much higher, around one gram.
So what does all this mean? How you apply it to your child is up to you, but you should talk to your pediatrician or allergist before changing his diet at all. The overall conclusion is that most kids with celiac disease will be just fine if they get a little gluten in their diets every day. For those who are allergic, it can be a little trickier. If anaphylaxis is possible, you want to avoid even trace amounts.