A more complex condition affects individuals who have gluten-sensitive enteropathy in which there is an autoimmune response to avenin, the glutinous protein in oats similar to the gluten within wheat.
[1] Studies on farmers with grain dust allergy and children with atopy dermatitis reveal that oat proteins can act as both respiratory and skin allergens.
[12] Nevertheless, the long-term effects of pure oats consumption are still unclear[14] and further studies identifying the cultivars used are needed before making final recommendations on their inclusion in the gluten-free diet.
The study, however, did find an increased number of patients with higher intraepithelial lymphocytes (IELs, a type of white bloodcell) in the oat-eating cohort.
[citation needed] In gluten-sensitive enteropathy, prolamins mediate between T-cells and antigen-presenting cells, whereas anti-transglutaminase antibodies confer autoimmunity via covalent attachment to gliadin.
This could indicate that coeliac disease does not directly involve avenin or that the sample size was too small to detect the occasional responder.
This study found that four patients had symptoms after oat ingestion, and three had elevated Marsh scores for histology and avenin responsive T-cells, indicating avenin-sensitive enteropathy (ASE).
Patients with DQ2.5/DQ2.2 tend to be the most prone toward gluten sensitive enteropathy (GSE), have the highest risk for GS-EATL, and shows signs of more severe disease at diagnosis.