Ask the Experts – August 2021

This month’s “Ask the Expert” features both Dascha Weir, MD, Associate Director, The Celiac Disease Program, Boston Children’s Hospital and Tara McCarthy, MS, RD, LDN, Clinical Nutrition Specialist, Boston Children’s Hospital. Tara offers guidance about setting up your kitchen in a new home. Dr. Weir talks about testing when you have both celiac disease and type 1 diabetes in the family.

Question - We are about to move. Before we set-up and start to use the kitchen I intend to do a thorough cleaning. I want to make sure I clean up any gluten residue from the family who last lived here. Is it necessary to get new appliances (oven and fridge) because of possible gluten residue? Or is a thorough cleaning sufficient?

Tara McCarthy - Congratulations on your move! Moving is hard and setting up a kitchen takes time. It is important to avoid cross contact in all situations. We would suggest cleaning down all surfaces inside and out and that includes the fridge and oven but you do NOT need to buy new appliances. This is a fresh start so it would be nice to organize your new kitchen so that gluten free foods are separate from gluten containing foods. Cleaning cabinets inside and out as well as all counter surfaces should also be included in your cleaning and set up plan. Everyone in the family should be aware of the process you set up in your kitchen and including the person with celiac while making decisions gives them a sense of control and belonging.

Question - I have once child with Type 1 diabetes (T1D) and one child with celiac disease (CD). I know that both conditions are autoimmune. Should I be testing the child with CD for T1D and the child with T1D for CD?

Dr. Weir - Both celiac disease and type 1 diabetes mellitus are autoimmune diseases.  Generally, a person with one autoimmune disease is at somewhat higher risk for developing another autoimmune disease.

In children with celiac disease, autoimmune thyroid disease and type 1 diabetes are the most common overlapping autoimmune conditions. While most children with celiac disease will not develop another autoimmune condition, gastroenterologists monitor their patients with celiac disease for signs or symptoms of these conditions by asking screening questions about both conditions, carefully following a child’s growth and periodically checking thyroid function tests.

Likewise, pediatric endocrinologists caring for children with type 1 diabetes routinely order bloodwork screening for celiac disease.  Approximately 5% of patients with type 1 diabetes also have celiac disease.  Most of these children have either asymptomatic celiac disease or symptoms that are mild.  Many will have undetected celiac disease at the time of their diabetes diagnosis. The celiac diagnosis is usually made within 6 years of the diabetes diagnosis.  In children with both celiac disease and type 1 diabetes, only 1 in 6 (17%) will be diagnosed with celiac disease before type 1 diabetes.

So, a child with type 1 diabetes should be screened for celiac disease with blood tests.  And a child with celiac disease should be monitored for clinical signs of type 1 diabetes.  Remember, non-diabetic siblings of a child with celiac disease should also be screened for celiac disease with blood tests approximately every 3 years or sooner if concerning symptoms arise.

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