Tolerance to oats in dermatitis herpetiformis

Objectives—Recent studies on coeliac diseasehave shown that oats can be included in a gluten-free diet withoutadverse effects on the small bowel. The presence of a rash is also asensitive indicator of gluten ingestion in dermatitis herpetiformis,and this was used to study whether patients with this disease could also tolerate oats.
Patients/Methods—Eleven patients with dermatitisherpetiformis in remission on a gluten-free diet were challenged dailywith 50 g oats for six months. Clinical symptoms were recorded, serum samples taken, and skin and small bowel biopsies performed before andafter the oat challenge. A control group comprised of 11 patients withdermatitis herpetiformis on a conventional gluten-free diet was also studied.
Results—Eight patients challenged with oatsremained asymptomatic, two developed a transient rash, and one withdrewbecause of the appearance of a more persistent but mild rash. Three of the 11 controls also developed a transient rash. IgA endomysial antibodies remained negative in all patients. The small bowel villous architecture, the densities of intraepithelial CD3 and α/βand γ/δ T cell receptor positive lymphocytes and crypt epithelial cell DR expression remained unaltered during the oat challenge.
Conclusions—The results confirm the absenceof oat toxicity on the gluten sensitive small bowel mucosa and suggestthat the rash in patients with dermatitis herpetiformis is notactivated by eating oats.

Keywords:dermatitis herpetiformis; coeliac disease; gluten-free diet; oats