Early introduction of high doses of gluten should be investigated further as a strategy to prevent coeliac disease (CD), UK researchers say.

Preliminary results from the Enquiring About Tolerance (EAT) Study showed a lower incidence of CD at three years in children who were given 4g of wheat protein a week from four months of age, compared to a control group who started consuming normal amounts of gluten after six months of age.

In the trial, published in JAMA Pediatrics, more than 1000 infants from the general population were randomised to either an intervention group in which they were given a high dose of gluten (two Weetbix) and other allergenic foods from the age 16 weeks, or a control group that continued with exclusive breastfeeding and avoidance of gluten and other allergenic foods until age six months.

When tested at age three years for antitransglutaminase type 2 antibodies, seven of 516 children from the control group (1.4%) had a diagnosis of CD confirmed vs none of the 488 children in the intervention group  (P = .02, risk difference 1.4%).

The mean quantities of gluten consumed in an early introduction group between age four and six months was 2.66 g/week, compared to 0.49 g/week in the control group.

All the children diagnosed with CD had anti-TG2 antibody levels greater than or equal to 10 times above the reference range and were positive for endomysial antibodies. Five were also positive for HLA-DQ2 or HLA-DQ8 and the two children with no HLA testing performed had biopsies showing classic signs of CD.

Six of seven children developed gastrointestinal symptoms directly before the diagnosis, and all experienced an improvement in symptoms once a gluten-free diet was introduced

The researchers from several hospitals in London and Seattle said their intervention trial differed from others in using early intervention with high doses of gluten. And unlike these previous studies, which had negative findings, the new trial suggested an effect of early gluten introduction on the prevalence of CD at age 3 years, they concluded.

“The results of this analysis suggest that it may have been premature to discount the effect of age of introduction of gluten on the development of CD … the results from the EAT Study suggest that a higher dose may be an important prevention strategy,” they wrote.

“This is the first study that provides evidence that early introduction of significant amounts of wheat into a baby’s diet before six months of age may prevent the development of coeliac disease. This strategy may also have implications for other autoimmune diseases such as Type 1 diabetes,” said lead author Professor Gideon Lack, Professor of Paediatric Allergy at King’s College London and head of the children’s allergy service at Evelina London Children’s Hospital said.

Co-author Dr Kirsty Logan said early introduction of gluten and its role in the prevention of coeliac disease should be explored further, “using the results of the EAT Study as the basis for larger clinical trials to definitively answer this question.”

Commenting on the findings, gastroenterologist Professor Jason Tye Din of the Walter and Eliza Hall Institute in Melbourne said they were intriguing given there had been a reversal in thinking on early introduction of peanuts  to ‘tolerise’ infants and prevent food allergy.

“This study really tried to answer the question of whether there’s a window period between four and six months of age where [gluten] is beneficial to the child. There’s been research showing that too much gluten before the age of five years might actually increase the risk of coeliac disease, but this study flies in the face of that,” he said.

“But because these were fairly small numbers of kids with coeliac I don’t think we’re in a position yet to make definitive recommendations,” he told the ABC.