Table 1:

Clinical characteristics and budesonide treatment

Case	Age (years)	Sex	GFD Duration (years)	Symptomsa						Symptom Duration following acute gluten reaction	tTG (U/mL)b	Treatment duration and dosage:	Clinical Responsec		Adverse events
				D	P	N/V	B	C	Extraintestinal manifestations				GI	Non-GI
1	28	F	12	D		N/V			Fatigue, rash	2–3 weeks	Normal	3 days: 9 mg daily	Substantial		None
2	32	F	12	D	P	N/V			Fatigue, brain fog	1 weekd	Normal		Substantial	Partial	None
3	18	F	3		P	N/V			Fatigue, Headaches	2 days	< 1 × ULNe	3 days: 6mg, 6mg, 3mg	Substantial		None
4	64	F	2	D	P	N/V			Headaches, flushing	Few days	Normal	9 days: 9mg/3d, 6 mg/3d, 3 mg/3d	Substantial		None
5	50	F	1	D	P	N/V			Fatigue	3 weeks	Unknown	10 days: 9mg daily	Substantial	No response	Headache
6	51	F	1		P		B		Brain fog, joint pain, ataxia	2 weeks	Normal	A few days: 9 mg daily until better	Response	Partial	None
7f	60	F	2		P	N/V	B	C	Fatigue, brain fog	2 weeks	Normal	3 weeks: 6 mg/2w, 3 mg/1w	Substantial	Partial for fatigue	None
8	41	F	11	D					None	1 week	<1 × ULNg	3 weeks: 9 mg/1w, 6 mg/1w, 3 mg/1w	Substantial	NA	None
9	43	F	4	D	P				None	Few weeks	Normal	3–4 weeks: 9 mg/1–2w, 6 mg/1w, 3 mg/1w	Response	NA	None
10	39	F	1.6	D	P	N/V	B		Fatigue, brain fog, joint pain	3–4 weeks	Normal		Partial		None
11	70	F	9	D					None	4 weeks	Normal		Substantial	NA	Constipation
12	56	F	2	D	P				None	2 days	Unknown		Response	NA	None
13	35	F	2.7		P	N/V			None	2 weeks	2 × ULNg	4 weeks: 9 mg daily	Partial	NA	None

F, Female; M, Male; D, Diarrhea; P, Abdominal pain; N/V, nausea and/or vomiting; B, Bloating; C, constipation; ULN, upper limit normal; w, week; d, day;

^aSymptoms of acute gluten exposure were similar to symptoms at CeD diagnosis, with the exception of case 4 and 9 who were asymptomatic at diagnosis (screened because of family history of CeD or osteoporosis) and after following a GFD, developed symptoms if exposed to gluten;

^bINOVA anti-human IgA TTG, borderline 20–30, positive >30;

^c“Substantial” response: patient-reported substantial decrease in symptom severity and duration compared to previous gluten exposures; “partial” response: some degree of improvement in terms of severity, but not duration; “response”: a clinical response was observed, but chart-review was insufficient to properly measure the extent of the response and effect on symptoms duration;

^dMostly non-GI symptoms, GI symptoms last about two days;

^ePatient was exposed several times at the college cafeteria before starting budesonide;

^fPotential CeD;

^gPreviously not strictly adherent to a GFD, but were on a strict GFD for at least six months at the time of acute symptoms and tTG were trending down.