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Early introduction of high‐dose gluten reduces the incidence of coeliac disease

Previous studies of the effect of early low-dose gluten introduction on coeliac disease are inconclusive. One aim of a UK randomised controlled trial was to study whether early introduction of high-dose gluten altered the incidence of coeliac disease. In the Enquiring About Tolerance (EAT) Study, 1303 children from the general population in England and Wales were randomised to consume six allergenic foods including wheat in addition to breast milk from age 4 months (early introduction group (EIG)) or to avoid allergenic foods and follow UK infant feeding recommendations of exclusive breastfeeding until approximately age 6 months (standard introduction group (SIG)). At age 3 years, 1004 children with available serum samples were tested for anti-transglutaminase type 2 antibodies; children with antibody levels >20 IU/L were referred for investigation for coeliac disease. The mean (SD) quantity of gluten consumed between ages 4 and 6 months was 0.49 (1.40) g/week in the SIG and 2.66 (1.85) g/week in the EIG (P < 0.001). Seven of 516 children from the SIG (1.4%) had confirmed coeliac disease versus none of 488 children in the EIG (P = 0.02, risk difference = 1.4%; 95% CI: 0.6–2.6). Early high-dose consumption of gluten should be considered as a strategy to prevent coeliac disease in future studies.