Gluten sensitivity covers a wide spectrum

Traditional teaching about celiac disease (CD) ignores the wide spectrum of this condition, which affects many atopic patients, a clinician says.

Before 2000, said John J. Zone, M.D., "It was taught that to have CD, people had to be malnourished, and experience diarrhea, bloating and abdominal pain shortly after eating gluten." Dr. Zone, professor and chairman of dermatology at the University of Utah School of Medicine, Salt Lake City, spoke at the 71^st annual meeting of the American Academy of Dermatology in Miami Beach, Fla.

Thanks to improved serologic testing, "We now know that at least 70 percent of patients with CD do not have those symptoms. People could have none of these symptoms and still have CD that's detected on blood testing and confirmed on biopsy," he said.

By these criteria, Dr. Zone said, approximately 1 percent of the U.S. population has CD. Though it can be asymptomatic, "It also can cause other problems including dermatitis herpetiformis. And there's evidence it could be contributing to other common conditions such as aphthous ulcers, alopecia areata and various types of eczema, which can also be exacerbated by gluten sensitivity."

Additional autoimmune diseases associated with CD include systemic lupus erythematosus, vitiligo, rheumatoid arthritis, Addison's disease, myasthenia gravis and autoimmune thyroiditis, he said.

Meanwhile, "There is increasing evidence for non-celiac gluten sensitivity." Such people experience reactions to gluten, he said, but do not have serologically detectable CD. Their symptoms can include abdominal discomfort, headaches and feelings of depression or overall malaise. Other symptoms can include rashes and numbness or tingling of the hands and feet, says Dr. Zone (Cash BD, Rubenstein JH, Young PE, et al. Gastroenterology. 2011;141(4):1187-1193).

In his laboratory, "We're working with taking the IgA antibody from the serum of patients with DH and transferring that antibody to severe combined immunodeficiency (SCID) mice (Zone JJ, Schmidt LA, Taylor TB, et al. J Immunol. 2011;186(7):4474-4480). Then we evaluate mechanisms that might stimulate production of inflammation in the human skin that's been transplanted to the mouse."

Eventually, Dr. Zone said he hopes to apply his group's findings to treating dermatitis herpetiformis in humans, using agents other than topical drugs.