www.aapnews.org Volume 36 • Number 1 • January 2015
Does timing of gluten
introduction with or without
breastfeeding prevent celiac
by Frank R. Greer, M.D., FAAP, and
Sarah Jane Schwarzenberg, M.D., FAAP
New studies have cast serious doubts on the
relationship between celiac disease (CD) and
breastfeeding as well as the importance of when
gluten is introduced into the infant diet.
In the last 50 years, improved methods of identifying CD have indicated that approximately 1%
of the population is affected. CD is a well-described immune-mediated disease triggered by
the ingestion of gluten in genetically susceptible
individuals. Symptoms are variable, and many
individuals with CD have no symptoms at all.
Elevated serum levels of anti-transglutaminase
IgA antibody (TTG) are a biomarker for active
disease, although biopsy proven CD has been
seen with negative TTG. CD is strongly associated with the human leukocyte antigen (HLA)
class II genes (HLA-DQ2 or HLA-DQ8) located on chromosome 6p21. Ninety-five percent
of individuals with CD express the HLA-DQ2
allele, and the remaining 5% the HLA-DQ8 allele. However, less than 50% of the population
carrying the at-risk genes develop CD.
Long-term follow-up studies in Sweden have
shown fluctuations in the median age of diagnosis
of CD that cannot be explained by genetic changes. This suggests that one or more environmental
triggers or lifestyle risk factors have changed over
time that turn on the genes for CD (Namatovu
F, et al. BMC Gastroenterol. 2014;14:59, www.
There has been a great deal of inconsistency
in the literature on the impact of breastfeeding
and timing of the introduction of gluten into the
diet on the development of CD. Some investigators and authorities even have suggested that
introduction of gluten to infants during a critical
In this issue
Chapter Views and News
from the AAP Department of Community,
Chapter and State Affairs
State elections on Nov. 4, 2014, for legislative
seats, constitutional offices and ballot measures
resulted in a shift in the political landscape, with
implications for state policy impacting child health
and pediatric practice.
Incumbent governors lost races in Alaska, Illinois
and Pennsylvania. In total, Republicans strengthened
their hold on governors’ mansions by a net gain of two.
Here is a brief look at the numbers:
• Republicans will hold majorities in 30 state
legislatures, and Democrats 11. Eight state leg-
islatures will have split party control, and one
(Nebraska) is nonpartisan.
• Republicans will hold 31 governorships, Democrats, 18, and one governor is an independent.
• Republicans will have full control of state governments (governor and both chambers of the legislature) in 23 states. Democrats will control seven
states, and 19 will be divided. Nebraska’s governor
is elected on a partisan ballot, but its one-chamber
legislature technically is nonpartisan.
A number of pediatricians ran for state office. Cal-
ifornia Assembly Member Richard J. Pan, M.D.,
M.P.H., FAAP, won his bid for the California Sen-
ate. Idaho House Minority Leader John M. Rusche,
M.D., was re-elected by 48 votes. First-term Nevada
Assemblyman Andrew M. Eisen, M.D, FAAP, lost
his race for re-election, and Everett J. Lamm, M.D.,
FAAP, was unsuccessful in his campaign for the New
Voters also made their voices heard on a number of ballot propositions, initiatives and referenda,
many of which have implications for child health
and pediatric practice.
Washington State voters approved I-594, a ballot initiative mandating background checks on all
gun sales and transfers, including those made at gun
shows and online. Voters also defeated a competing
ballot initiative that would have prohibited background checks unless required by federal law.
Voters in Alaska, Oregon and Washington, D.C.,
approved ballot initiatives that legalize marijuana for
recreational use. Though Washington, D.C., passed
a recreational marijuana ballot initiative with 69%
of the popular vote, the law must be certified by the
city council and survive congressional review prior
to becoming law.
Florida voters rejected a ballot initiative that
would have legalized medical marijuana. The measure won support of 57% of voters, but 60% was
needed for approval.
See Gluten, page 10
State election results have implications
for children, pediatricians
See Elections, page 8
Photo courtesy of Robert Alan Jamison, M.D., FAAP
In Uganda, volunteer Robert Alan Jamison, M.D., FAAP, treats a boy with severe malaria who later recovered.
After 27 years in practice in Morristown, Tenn., Dr. Jamison found a new vocation in humanitarian medicine.
Pediatrician responds to call of global medicine
For 30 years, AAP News
has served pediatricians as
the trusted source of timely
information. This month’s
Did You Know column explores the publication’s
range of impact on pediatricians’ practice and learning