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Respuesta inmunológica de niños celiacos a la vacuna frente a la hepatitis B / Immune response to hepatitis B vaccination in children with celiac disease

Acta Pediatr Esp; 75(7/8): e102-e108, jul.-ago. 2017. tab
Article in Spanish | IBECS | ID: ibc-165544

Abstract

Introducción: Se ha descrito la mala respuesta a la vacuna antihepatitis B (VAHB) de los pacientes celiacos, pero existe controversia sobre si se debe a la presencia de genotipos específicos del antígeno leucocitario humano en estos pacientes o a la ingesta de gluten. El objetivo de este estudio es determinar la respuesta inmunológica a la VAHB en niños celiacos en relación con el consumo de gluten. Pacientes y métodos: Estudio cuasiexperimental. Se comparó la situación vacunal frente al virus de la hepatitis B en dos grupos de niños celiacos: uno formado por los niños que recibieron la pauta convencional a los 0-2-6 meses de edad, y el segundo formado por quienes no respondieron a esta primovacunación y fueron revacunados durante el estudio, siguiendo una dieta exenta de gluten. Se usó la prueba exacta de Fisher para determinar la significación bilateral en el análisis de las diferencias en las tasas de respuesta entre ambos grupos. Resultados: De los 43 niños primovacunados en edad neonatal, respondieron adecuadamente 17 (39,5%). De los 24 niños revacunados mientras mantenían una dieta exenta de gluten, todos respondieron a la vacunación (100%; intervalo de confianza del 95%: 85,8-100), con una significación bilateral (p= 0,0000002) en la prueba exacta de Fisher. Conclusiones: Los niños celiacos presentan una respuesta menor a la VAHB si ésta se produce en la edad neonatal que si se produce una vez el paciente se encuentra en tratamiento con una dieta exenta de gluten. La actividad de la enfermedad celiaca, directamente relacionada con el consumo de gluten, representaría el motivo fundamental en esta falta de respuesta (AU)
Introduction: A poor response of patients with celiac disease to the hepatitis B virus (HBV) vaccine has been reported, but there is controversy about its cause: it is unknown whether it is due to the presence of specific human leukocyte antigen genotypes among these patients, or by gluten intake. The aim of this study is to determine the immune response to the HBV vaccine in children with celiac disease in relation to gluten intake. Patients and methods: Quasi-experimental study. Vaccination status against HBV was compared in two groups of children with celiac disease: the first one was made up of children who received a conventional vaccination schedule at 0-2-6 months of age, and the second one was made up of those who did not respond to this primary vaccination and were revaccinated during the study, while they were following a gluten-free diet. Fisher’s exact test was used to determine the bilateral significance in the analysis of differences in response rates between the two groups. Results: Responsiveness to HBV vaccine was observed in 17 of the 43 (39.5%) children who received their primary vaccination in neonatal age. Twenty-four children were revaccinated as they were following a gluten-free diet and all (100%) responded properly, with a bilateral significance (p= 0.0000002) in Fisher’s exact test. Conclusions: Children with celiac disease have a lower response to HBV vaccine in neonatal age than when they are treated with a gluten-free diet. Our study suggests that the activity of the celiac disease, which is directly related to gluten intake, may be the main reason for this lack of response (AU)
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