A Unique Child - Health: A Guide to ... Coeliac disease

What is coeliac disease?

Coeliac disease is a lifelong auto-immune disease, caused by intolerance to gluten, a protein found in the cereals wheat, rye and barley. Some people with coeliac disease may also be sensitive to oats. When eating gluten it causes damage to the lining of the gut, which means food cannot be absorbed properly. Coeliac disease is not contagious.

What are the symptoms?

Symptoms may include diarrhoea, nausea, vomiting, abdominal pain and excessive wind.

How is coeliac disease diagnosed?

The first step to diagnosis is a simple blood test, which looks for antibodies that the body makes in response to eating gluten.

The second step is a gut biopsy. This involves a thin flexible tube (an endoscope) being passed via the mouth and stomach and into the small intestine. Small samples of the gut lining (biopsies) are collected and later examined under a microscope to check for abnormalities typical in coeliac disease.

It is important that gluten is not taken out of the diet until the blood test and gut biopsy are complete, or else the tests will not be conclusive.

How is it treated?

A life-long gluten-free diet is the treatment for coeliac disease. By switching to a gluten-free diet, the gut starts to heal and symptoms will allay. A person established on a gluten-free diet will not be 'unwell'.

What is gluten?

Gluten is a protein that is found in the cereals, wheat, rye and barley. Some children may also be sensitive to oats.

What is the difference between food allergy, intolerance and coeliac disease?

Food allergies: generated by the immune system and occur within seconds or minutes of eating the food in question. Tiny amounts can cause potentially life-threatening allergic reactions, such as anaphylactic shock.

Food intolerance: not triggered by the immune system and generally not life-threatening.

Coeliac disease: an auto-immune disease. If a person ingests gluten by mistake, they will not suffer an anaphylactic reaction. It will, however, trigger an immune response which may take hours or even a couple of days to appear. The person may experience symptoms such as diarrhoea, nausea, vomiting, abdominal pain and wind. There are long-term health problems associated with untreated coeliac disease.

What should I do if a child at my nursery has Coeliac disease?

It is important that all food and drink is gluten-free and that all staff are aware of the need for extra care in preparation of meals and snacks to avoid cross-contamination with gluten-containing products. Information on foods that are gluten-free, food preparation and cross-contamination can be obtained from Coeliac UK.

Some play activities will need careful thought, as play dough, dried pasta and some other art and craft products may contain gluten. Although gluten has to be ingested (eaten), these can potentially cause a problem in young children as they tend to put their fingers in and out of their mouths.

What foods contain gluten?

Some of the obvious products are: bread, pasta, cakes, biscuits, pizza base, bread sticks, battered and bread products and breakfast cereal containing wheat, barley or rye. The not so obvious: soups, sauces, sausages, burgers, readymeals, ice cream, stock cubes.

What foods are gluten-free?

There is a wide variety to choose from, including basic foods, such as fruit and vegetables, pulses, meat and fish (plain), milk and cream, cheese, eggs, plain yogurt, potatoes, rice, fizzy drinks (apart from cloudy varieties), squashes (apart from barley water), pure fruit juices, butter and margarines, jam, marmalade, honey, golden syrup, Marmite, Bovril, and sugar.

Gluten-free alternatives are widely available from all major supermarkets, including gluten-free bread, pasta, cakes, biscuits, sausages, burgers and many more.

How to avoid cross-contamination

Anyone preparing food for someone with coeliac disease should be aware of the risk of cross-contamination and the following steps should be taken:

- wash surfaces before preparing food

- use separate toasters for gluten-free bread or toaster bags

- cook gluten-free and food containing gluten in separate dishes

- serve gluten-free foods with separate plates and utensils

- store gluten-free snacks such as biscuits in a separate container

- use separate containers of butter, margarine, jams etc, as knives can transfer crumbs from normal bread.

FURTHER INFORMATION

Contact Coeliac UK, 3rd Floor, Apollo Centre, Desborough Road, High Wycombe, Bucks HP11 2QW, helpline: 0870 444 8804, www.coeliac.org.uk