Neuroimmunological overlap syndromes in optic neuritis, myelitis, and connective tissue diseases.

Coeliac disease (CD) is an autoimmune disease resulting in gluten intolerance. Gluten is a protein found in barley, wheat, and rye. The main treatment for CD is lifelong adherence to a gluten-free diet (GFD). One of the greatest challenges for families with children with CD, is the high costs of GF-foods which can range between 150% and 200% higher than similar gluten containing foods. Previous work has shown that gluten-free food insecurity (GF-FI) can range between 30% and 50% in households with children with CD in Canada, with more than 2/3 of families experiencing moderate-to-severe GF-FI. The consequences of GF-FI in households with children with CD includes lower child adherence to the GFD and reduced diet quality. All of these factors place the child with CD living in GF-FI households at high risk for long-term health consequences such as poor bone health and/or growth failure. In Canada, there are limited government policies to address the high rates of GF-FI for children and adults living with CD. The current taxation credit that is in place for Canadians living with CD is complex and cumbersome to use, requiring the calculation of marginal costs between GF-foods and comparable gluten containing food items. In addition, the tax credit doesn’t address the burden of high GF-food costs directly, and thus has no direct benefit to families without taxable incomes. While other government policy approaches have been proposed (e.g. defined child tax or disability credit), there are no specific health policies for families with children with CD to address GF-FI. Hence, parents living in GF-FI households are faced with the dilemma of making decisions regarding income allocation between high GF-food costs and other important household expenditures (e.g. rent/mortgage payments). Little is known regarding parental perceptions related to the mediators of GF-FI in households with children with CD or the health policies that parents deem to be important. The study aim was to describe parental perceptions regarding perceived barriers and facilitators of household GF-FS and to explore the food policies parents deem necessary to help combat household GF-FI.