Role of food allergy-intolerance in coeliac patients with persistence of symptoms after a gluten-free diet

The role played by intolerance to foods other than gluten in 150 child coeliac patients, has been studied. Following a strictly gluten-free diet for at least one month, 24 of them presented persistent chronic diarrhoea and little increase in weight. These symptoms disappeared in 22 of the 24 cases after a diet eliminating cow milk and foods for which skin tests produced positive responses. A subsequent provocation test led to the reappearance of diarrhoea in 22 cases after 48-72 hours. Xylose absorption test was abnormal before the elimination diet, normal after the elimination diet, and abnormal after double-blind provocation test with the suspect foods. Age at diagnosis of coeliac disease was significantly higher and family history of atopy significantly more common in the 24 cases with persistence of symptoms than in the 126 cases without persistence of symptoms. Differences (not significant) emerged between the two groups as regards the incidence of other allergic illnesses, levels of total IgE and specific IgE, or positive responses to skin tests. The results obtained suggest that in the coeliac patients with persistence of symptoms despite an appropriate gluten-free diet should be considered a food intolerance, associated to coeliac disease.