The Long-Term Safety and Quality of Life Effects of Oats in Dermatitis Herpetiformis

Abstract

The treatment of choice for dermatitis herpetiformis (DH), a cutaneous manifestation of coeliac disease, is a life-long gluten-free diet (GFD). In a GFD, wheat, rye and barley should be strictly avoided, but the role of oats is more controversial. This study aimed to investigate the safety and long-term quality of life and health effects of oat consumption in 312 long-term treated DH patients. Baseline data were gathered from patient records and follow-up data from questionnaires or interviews, and validated questionnaires were used to assess quality of life. We found that altogether 256 patients (82%) were consuming oats as part of their GFD at the follow-up. Long-term follow-up data showed that there were no differences in the presence of long-term illnesses, coeliac disease complications or the usage of medication between those consuming and not consuming oats. However, oat consumers had a better quality of life and reported ongoing gastrointestinal symptoms less frequently (4% vs 19%, p = 0.004) at the follow-up than those not consuming oats. The study established that oats are safe for DH patients and in the long-term seem to improve the quality of life of DH patients.

Dermatitis Herpetiformis: An Update on Diagnosis and Management

“…However, the severity of the rash varies between individuals, and a more intense rash may also affect other sites, such as the scalp, face, and upper back. The clinical picture and severity of the DH rash seem to have remained unchanged over recent decades [ 30 ] without becoming milder or otherwise nonclassical as seen in celiac disease [ 21 , 31 ]. The itch in DH is very prominent; in half of the patients, it is a constant finding and correlates with common sleep disturbances [ 32 ].…”

“…A GFD means the permanent avoidance of wheat, barley, rye, and all foods containing these cereals. The safety of oats in DH has been demonstrated in two short-term challenges and one long-term follow-up study [ 30 , 75 , 76 ]; oats are currently allowed as part of a GFD in many countries. However, oats may easily become contaminated by gluten traces from other cereals, and it is important to ensure that only noncontaminated pure oats are used [ 74 ].…”

“…However, oats may easily become contaminated by gluten traces from other cereals, and it is important to ensure that only noncontaminated pure oats are used [ 74 ]. In Finland, uncontaminated oat products have been available for 20 years, and 82% of patients with DH on a GFD currently regularly consume oats [ 30 ]. Including oats in the diet helps to increase daily fiber consumption.…”

“…Long-term follow-up of Finnish patients with DH indicated that >90% adhere to a GFD, usually strictly [ 30 , 80 ]. Importantly, adherence to a GFD normalizes lowered quality of life within 1 year [ 64 ].…”

“…Persistent gastrointestinal symptoms known to occur in treated celiac disease appeared to not affect these patients, and the quality of life paralleled that of controls [ 97 , 98 ]. In addition, the consumption of oats within the GFD had no effect on quality of life [ 30 ].…”