Review article: safe amounts of gluten for patients with wheat allergy or coeliac disease C. HISCHENHUBER* 1 , R. CREVEL  , B. JARRY à , M. MA ¨ KI§, D. A. MONERET-VAUTRIN – , A. ROMANO**, R. TRONCONE   & R. WARD àà *Nestle ´, Nestec Quality Management, Vevey, Switzerland;  Safety & Envir- onmental Assurance Centre, Unilever, Colworth House, Sharnbrook, Bedford, UK; àACS Partners, Paris, France; §Paediatric Research Centre, Univer- sity of Tampere Medical School and Tampere University Hospital, Tampere, Finland; –Universite ´ de Nancy – Ho ˆ pital Central, Medicine Interne, Immunologie Clinique et Allergologie, Nancy, France; **Universita ` Cattolica del Sacro Cuore C.I. Columbus, Rome and Oasi Maria SS, Troina, Italy;   Department of Paediatrics and European Laboratory for the investigation of food induced diseases, University ‘Federico II’, Naples, Italy; ààPepsiCo International, Thurmaston, Leicester, UK Correspondence to: ILSI Europe, a.i.s.b.l. Avenue E. Mounier 83, Box 6, B-1200 Brussels, Belgium. E-mail: publications@ilsieurope.be 1 All authors contributed equally to this study. Publication data Submitted 23 May 2005 First decision 15 June 2005 Resubmitted 16 November 2005 Accepted 16 November 2005 SUMMARY For both wheat allergy and coeliac disease the dietary avoidance of wheat and other gluten-containing cereals is the only effective treat- ment. Estimation of the maximum tolerated amount of gluten for sus- ceptible individuals would support effective management of their disease. Literature was reviewed to evaluate whether an upper limit for gluten content in food, which would be safe for sufferers from both diseases, could be identified. When setting gluten limits for coeliac disease suf- ferers, the overall potential daily intake should be considered, while for wheat allergy limits should be based on single servings. For coeliac dis- ease sufferers this limit should lie between 10 and 100 mg daily intake. For wheat allergy, lowest eliciting doses for children lie in the lower milligram range, while for adults they are most significantly higher. Gliadins (part of the gluten proteins) not only trigger coeliac disease, but are also major allergens in wheat allergy. Therefore, measurement of gliadins with validated enzyme-linked immunosorbent assay methods provides an appropriate marker for assessing gluten and/or wheat pro- tein contents in food. Available data suggest that a maximum gluten content for ‘gluten-free’ foods could be set, which protects both wheat allergy sufferers and coeliac patients. Aliment Pharmacol Ther 23, 559–575 Alimentary Pharmacology & Therapeutics ª 2006 International Life Sciences Institute (ILSI) 559 Journal compilation ª 2006 Blackwell Publishing Ltd doi:10.1111/j.1365-2036.2006.02768.x