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To the Editor: Celiac disease is a gluten-induced enteropathy, the treatment of which consists of permanently withdrawing dietary gluten. Adherence to diet is crucial for intestinal mucosal recovery, relief of symptoms, and prevention of intestinal T-cell lymphoma.1 The amount of gluten needed to cause mucosal injury varies. Some patients can tolerate up to 5 g of gluten daily; others have intolerance after minimal exposure.Two patients, both living in farming communities, were referred with nonresponsive celiac disease. Characteristics of the patients are shown in Table 1. Despite strict gluten-free diets, their symptoms and histologic changes persisted. Both were feeding cattle in . . .