Oats, celiac disease biopsy

In addition to the pivotal studies, several publications (Table 6.2) used other methods to test the response of individuals with celiac disease who were introduced to oats. These studies did not fulfill the selection criteria of pivotal studies namely an in vivo oats challenge with an intestinal/skin biopsy to assess the biological response to the introduction of oats into an otherwise gluten-free diet. Instead, they used various in vitro techniques to assess the immune response to avenin, or serology without an intestinal mucosal biopsy. Most of the methods used duodenal mucosal cultures prepared from biopsies or intestinal T cell lines obtained from individuals with celiac disease. Other studies measured the immunogenic reaction in peripheral lymphocytes or measured the presence of various antibodies in individuals with verified celiac disease who included oats in their diet, in comparison with a reference group (Table 6.2). Some of these studies used patients that were previously included in pivotal studies. These studies are identified with an asterisk ( ) in Table 6.2. 

In patients with celiac disease and dermatitis herpetiformis, no adverse effects were seen after ingestion of 2.5 g of the protein avenin daily (equivalent to 300 g of oats, or about 10 bowls of oatmeal) for 5 days. Biopsies of the small intestines indicated that that avenin did not change the ratio of the villous height to the crypt depth, the height of enterocytes, or intraepithelial lymphocyte counts (Hardman et al. 1999). 

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