What to Expect For Your/Your Child’s Gluten Challenge

A gluten challenge can help you/your child and the care team diagnose celiac disease. In this handout, you will learn what to expect for your/your child’s gluten challenge.

What is a Gluten Challenge?

A gluten challenge is sometimes needed to diagnose celiac disease. For a gluten challenge, a person temporarily adds foods with gluten back into their diet. After 4-8 weeks, doctors check the person’s blood for gluten antibodies (proteins in the blood the body makes in response to gluten). Doctors also do an endoscopy to check for damage to the small intestine. An endoscopy is an imaging procedure in which doctors look at a person’s digestive tract (throat, stomach and small intestine).

For these tests to be accurate, you/your child must temporarily add gluten back into your/their diet.

How Much Gluten Will I/My Child Eat for the Gluten Challenge?

In most cases, you/your child will eat about 1-2 slices of bread or one serving of food that contains gluten (½ cup of pasta, 2-3 cookies, ¾-1 cup of cereal) per day for 4-8 weeks. It takes the body some time to respond to gluten. This is why the challenge lasts for a few weeks.

Why Do I/My Child Need to Do a Gluten Challenge?

If you/your child have celiac disease and start a gluten-free diet before getting diagnosed, your/their body stops making gluten antibodies and the intestine heals. On a gluten-free diet, tests for celiac disease come back negative, even though you/your child might have the disease.

Are Gluten Challenges Safe?

Yes. Under the care team’s guidance, a gluten challenge is often uncomfortable, but safe. If you/your child have not been diagnosed with celiac disease and follow a gluten-free diet, it is currently the only way to get a proper diagnosis. Any symptoms or signs of damage to the small intestine should improve after starting a gluten-free diet.

Doctors do not recommend gluten challenges for children under 5 years old, teenagers going through puberty or pregnant women.

What Side Effects Can I/My Child Expect During a Gluten Challenge?

While gluten challenges are uncomfortable for most people, symptoms can be different for everyone. Some people may not have side effects. Others notice symptoms return right away.

There are many side effects that you/your child might have during a gluten challenge. Side effects can include:

• Changes in bowel habits, such as constipation or diarrhea
• Bloating or gas
• Abdominal (belly area) pain
• Weight loss
• Joint pain
• Brain fog or exhaustion
• Depression
• Anemia (low iron levels in the blood)

What If I/My Child Cannot Handle the Side Effects From the Gluten Challenge?

Although it might take 4-8 weeks (or longer) for gluten antibodies to show up in a blood test, the intestine may be damaged earlier in the challenge. If you/your child cannot handle the side effects and want to stop the challenge early, tell the care team. The doctor might still be able to see damage to the intestine with an endoscopy. You/your child should always feel comfortable speaking with the care team if you/they feel too sick to continue the gluten challenge.

I/My Child Feel Better on a Gluten-Free Diet. Why Do I/They Need an Official Celiac Disease Diagnosis?

You may believe that you/your child have celiac disease if you/they feel better on a gluten-free diet. You/they might also think that you/they do not need an official diagnosis if symptoms improve.

While this is understandable, there are many reasons why it is very important that you/your child are diagnosed with celiac disease before following a strict gluten-free diet:

• If you/your child does have celiac disease, you/they will need to see a doctor for ongoing care. Doctors might also recommend that everyone in your immediate family gets checked for signs of celiac disease. Documentation of an official diagnosis is needed to access certain accommodations, including special meals at school.
• If you/your child does not have celiac disease, avoiding a diagnosis might mean delaying the diagnosis of another condition with similar symptoms. You/your child might also be missing out on important nutrients in foods with gluten.

If I/My Child Do Not Have Celiac Disease, Why Do I/They Feel Better on a Gluten-Free Diet?

There are many reasons why you/your child might feel better eating a gluten-free diet. This does not mean you/they have celiac disease. Reasons can include:

• Making healthier food choices
• Sensitivity to gluten not caused by celiac disease that does not damage the intestine
• Wheat allergy
• Placebo response to their new diet (when a person who is sick feels better because they expect to feel better)

Following a gluten-free diet is a big commitment. For people with gluten sensitivity or a wheat allergy, doctors might recommend a gluten-free diet. People with these conditions do not have to follow the gluten-free diet as closely and strictly as people with celiac disease. It is very important for you/your child to know which gluten-related condition you/they have. This helps you/them know how carefully to follow a diet.

Did You Know...?

It is not healthier or necessary to follow a gluten-free diet if you/your child do not have celiac disease. Before removing gluten from your/your child’s diet, ask the care team if it is medically necessary.

Rev. 03/2021. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used as treatment of any medical conditions.