A: Dermatitis herpetiformis is a skin disease caused by an intolerance to gluten. It is a form of celiac disease, the inherited autoimmune intestinal disorder that affects between one in 100 and one in 200 people worldwide. Gluten, found in the grains wheat, rye and barley, damages the small intestine and can also affect other body systems, such as the skin. About 10 per cent of celiacs will also have dermatitis herpetiformis (DH).

Although most people with DH have varying degrees of small intestinal damage, many will have no or few bowel complaints typically associated with celiac disease.

The DH skin rash burns and itches intensely. It is symmetrically distributed and usually found on the elbows, knees and buttocks. It also can appear on the back of the neck, upper back, scalp and hairline. Groups of small blisters will form that will erupt into small red lesions.

The condition typically appears between the ages of 20 to 45, but can occur at other times. It is most common in people of northern European descent and rare in Asians and African-Americans.

DH is often misdiagnosed as other skin conditions such as herpes, eczema, contact dermatitis, hives or psoriasis and treated with a variety of topical creams. The only way to diagnose DH is a skin biopsy from unaffected skin adjacent to blisters or lesions. A biopsy of the small intestine, normally used to diagnose celiac disease, is not essential if the skin biopsy tests positive for DH.

Next: Managing dermatitis herpetiformis

A: Quinoa (pronounced “keen-wah”) was a staple of the Incas who called it “the mother grain”. It is not actually a grain but a seed from a broad-leafed plant that is closely related to the weed lamb’s quarters and to spinach. Numerous varieties are grown in South America, and more recently in North America as well.

The quinoa seed looks like a cross between millet and sesame seed and is protected by a bitter, resin-like substance called saponin, which should be rinsed off before cooking. Some companies remove the saponin (like NorQuin brand) making it pan-ready, but quinoa is sold in several forms. (See below.)

It is a nutritious, gluten-free alternative that contains more high-quality protein than any other grain or cereal. In fact, its protein quality is comparable to that of dried skimmed milk. Quinoa is also high in iron, magnesium, phosphorus and zinc, and is a source of calcium, B vitamins and fibre.

How to Use:
• side dish instead of potatoes or rice
• in salads or pilafs, stuffing, casseroles
• thickener for soups, stews and chili

Cooking Tips
• rinse quinoa in cold water, drain.
• In a saucepan with a tight lid, bring 1 cup of quinoa and 2 cups liquid to a boil. Simmer for 15 minutes or until liquid is absorbed.
• let stand covered for 5 minutes.
Makes 3 cups.

How to Use:
• breakfast cereal
• substitute for up to 1/3 of the g-f flour in a cookie, muffin or bread recipe
• add to pancakes or waffles

Cooking Tips:
• add 1⁄3 cup flakes to 1 cup boiling water and boil 1 ¹⁄_² to 2 minutes, stirring frequently.
• remove from heat and cool. Then add chopped nuts, dried fruits and brown sugar.
• Or in microwave: high heat for 2 to 2 ¹⁄_² minutes.

How to Use:
• in baked items such as breads, muffins, pancakes, cookies, biscuits

Cooking Tips:
• has a slightly nutty, strong flavour so best combined with other g-f flours. Use no more than 25 per cent quinoa flour in recipe

How to Use:
• as a side dish or in salads

Cooking Tips:
• Follow directions on package.
Cooking time varies.

Shelley Case, RD: In a sense, you’re right on both counts. Historically, oats were not allowed on the gluten-free diet (GF diet) used to treat those with celiac disease. Oats were believed to trigger the same toxic reaction in the small intestine as wheat, rye and barley. However, many studies from Europe and the U.S. reveal that consumption of oats is safe for the majority of children and adults with celiac disease. Most of these studies used pure, uncontaminated oats, but it should be noted that a very small number of individuals with celiac disease may not even tolerate pure oats. The mechanism causing this intolerance has yet to be established.

Related: Essential guide to celiac disease

Based on this new research, a growing number of health professionals and celiac organizations around the world now allow consumption of moderate amounts of pure, uncontaminated oat products in a GF diet. Health Canada has issued a position paper on the safety of oats in celiac disease. The Canadian Celiac Association Professional Advisory Board, in consultation with Health Canada, has developed a position statement on using pure, uncontaminated oats. It says that adults with celiac can safely consume half to three-quarters of a cup (50 to 70 grams) of dry rolled oats per day. For children, it’s one-quarter cup (20 to 25 grams) per day.

Unfortunately though, most commercial oat products on the market have been cross-contaminated with wheat, barley and/or rye, which occur during harvesting, transportation, storage, milling, processing and packaging.

The good news is there are specialty companies in North America and Europe who produce pure, uncontaminated oat products that are grown on dedicated fields and equipment and packaged in dedicated gluten-free facilities. Cream Hill Estates (Lara’s brand) and Avena Foods (Only Oats brand) are the Canadian companies. The American companies include Bob’s Red Mill, Gluten-Free Oats, Gifts of Nature and Montana Monster Munchies (Legacy Valley).

Many other companies are using these pure, uncontaminated oats from the producers listed above (and in the chart below) in their gluten-free products. Examples include Glutenfreeda Foods oatmeal, NoNuttin granola bars and granola, and Holly’s oatmeal.

Before adding pure, uncontaminated oat products to your diet, I recommend that you consult with your physician and dietitian. It is also very important that your celiac disease be well-controlled on the GF diet and that you have no gastrointestinal complaints.

A diet containing oats is often higher in fibre than the typical GF diet, therefore some individuals may experience a change in stool pattern or mild gastrointestinal symptoms such as abdominal bloating and gas. This will resolve as the body adjusts to the change in the amount and type of fibre. When adding a new fibre source such as oats, it is important to consume more fluids, especially water.

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• Tricks to easy gluten-free eating
• Allergic Living’s gluten-free recipes
• Miley Cyrus on her gluten “allergy”

Shelley Case is a consulting dietitian and author of Gluten-Free Diet: A Comprehensive Resource Guide. She is on the advisory boards of the Canadian Celiac Association, the Celiac Disease Foundation and Gluten Intolerance Group.

Thank you for understanding that Shelley won’t be able to answer every question received. The editors at Allergic Living highly recommend her book Gluten-Free Diet, a vital resource for those interested in celiac disease and living gluten-free.