New look on oats in coeliac disease

Abstract

The suitability and tolerability of oats has been a long-standing controversy in the management of coeliac disease (CD). In Europe and the USA, pure oats are recommended for their nutritional benefits, palatability and desire by the patients with CD, whereas Australia and New Zealand have excluded oats from gluten-free diets due to safety concerns. In Gut , the research group of Jason Tye-Din publishes a unique and ground-breaking study on the immune reaction and tolerability of oats in CD.1 It is well known and studied that the ‘gluten-like’ proteins of wheat, rye and barley are harmful in CD—but what about the close cousin oats? There is an issue of contamination of oats with other cereals, and the patients have been well educated to rely on uncontaminated oats—but is this really the whole story? This commentary delves into these findings and their implications for dietary guidelines and clinical practice. The investigators undertook a large effort to isolate oat avenin—the counterpart of wheat gluten. From 400 kg of contamination-free oats, they had 2.1 kg to use. This powder was used for clinical oat re-challenge in a total of 33 well-treated patients with CD allowing ingestion of oat avenin corresponding to as much as 12 servings of porridge. They recorded symptoms and collected serum in the first hours during challenge, in consideration of the knowledge that gluten challenge in patients with CD induces nausea and interleukin 2 (IL-2) release.2 3 The investigators performed challenges with either single bolus, 6-week oat avenin or 3 months whole oats in patients with …