eng Science and Education Publishing International Journal of Celiac Disease 2334-3486 2018-04-02 6 1 4 6 10.12691/ijcd-6-1-3 IJCD2018613 article Finlay Macrae AO Finlay.Macrae@mh.org.au 1 Department of Medicine, University of Melbourne, The Royal Melbourne Hospital, Australia For the first time since discovery of celiac disease and introduction of gluten-free diet (GFD) there are some treatments that could be called adjuncts to the GFD for the management of celiac disease (CD) and dermatitis herpetiformis (DH). The most clinically advanced approaches are based on enzymatic detoxification of traces of gluten often present in seemingly gluten-free foods. Maintenance of GDF is difficult for many patients due to undeclared levels of gluten even in 'gluten free' products. Enzyme supplementation enables detoxification of 'hidden' gluten and guards against gluten before it can damage intestinal mucosa and stimulate the immune system. Controversy rests as to whether such advances should be encouraged for patients with celiac disease, whose behaviour then might impact on their commitment to maintain a gluten free diet. http://pubs.sciepub.com/ijcd/6/1/3/ijcd-6-1-3.pdf celiac disease enzyme therapy gliadin peptides dermatitis herpetiformis caricain gluten clinical studies