Should all patients with dermatitis herpetiformis follow a gluten-free diet?

Physical and molecular changes during the storage of gluten-free rice and oat bread

Gluten-free bread crumb generally firms more rapidly than regular wheat bread crumb. We here combined differential scanning calorimetry (DSC), texture analysis, and time-domain proton nuclear magnetic resonance (TD (1)H NMR) to investigate the mechanisms underlying firming of gluten-free rice and oat bread. The molecular mobility of water and biopolymers in flour/water model systems and changes thereof after heating and subsequent cooling to room temperature were investigated as a basis for underpinning the interpretation of TD (1)H NMR profiles of fresh crumb. The proton distributions of wheat and rice flour/water model systems were comparable, while that of oat flour/water samples showed less resolved peaks and an additional population at higher T2 relaxation times representing lipid protons. No significant crumb moisture loss during storage was observed for the gluten-free bread loaves. Crumb firming was mainly caused by amylopectin retrogradation and water redistribution within bread crumb. DSC, texture, and TD (1)H NMR data correlated well and showed that starch retrogradation and crumb firming are much more pronounced in rice flour bread than in oat flour bread.

Management of dermatitis herpetiformis

The major treatment strategies for DH are gluten restriction or medical treatment with sulfones. Control of the cutaneous manifestations, but not the gastrointestinal changes, is rapid with dapsone. In addition to control of the cutaneous signs and symptoms of DH, dietary gluten restriction also induces improvement of gastrointestinal morphology and is possibly protective against the development of lymphoma.