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Gluten challenge

Testing for coeliac disease is most accurate when a person is still consuming gluten. Starting a gluten free diet before testing can cause falsely negative and unreliable results. If gluten has been removed from the diet for a number of months, a gluten challenge will be required to allow for a conclusive diagnosis. A HLA gene test, if negative, can be used to exclude a diagnosis of coeliac disease. A positive HLA gene test result is not diagnostic and a gluten challenge followed by testing will still be required to establishthe diagnosis.

The following options can be discussed with your patient:​

Option 1

Recommend a gluten challenge. One option is to recommend 8-10g gluten per day (for adults) for 6 weeks prior to testing. This is equivalent to approximately 4 slices of wheat-based bread per day. Our fact sheet, Gluten Challenge, has more information.​

Option 2

If your patient is reluctant or unable to complete a gluten challenge, offer HLA-DQ2/8 gene testing. If HLA DQ2/8 gene testing is negative, coeliac disease can be safely excluded. If it is positive, then option 1 is the only feasible diagnostic approach.​

Gluten challenge is discouraged in children under the age of 5 years and during the pubertal growth spurt because of potential negative effects on growth.
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