RESUMEN
BACKGROUND AND OBJECTIVES: Celiac disease (CeD) is associated with psychopathology in children. It is unknown whether this association is present in children with celiac disease autoimmunity (CDA) identified by screening. We examined the associations between subclinical CDA and emotional and behavioral problems in children without previous CeD diagnosis. METHODS: In a population-based cohort study of 3715 children (median age: 6 years), blood titers of tissue transglutaminase autoantibodies were analyzed. CDA was defined as a measurement of tissue transglutaminase autoantibodies ≥7 U/mL (n = 51). Children with previous CeD diagnosis or children on a gluten-free diet, were excluded. The Child Behavior Checklist (CBCL) was filled in by parents and was used to assess behavioral and emotional problems of children at a median age of 5.9 years. Multiple linear regression models were applied to evaluate the cross-sectional associations between CDA and CBCL scores. Sensitivity analyses were done in a subgroup of children who were seropositive carrying the HLA antigen risk alleles for CeD. RESULTS: In basic models, CDA was not associated with emotional and behavioral problems on the CBCL scales. After adjustment for confounders, CDA was significantly associated with anxiety problems (ß = .29; 95% confidence interval 0.02 to 0.55; P = .02). After exclusion of children who did not carry the HLA-DQ2 and/or HLA-DQ8 risk alleles (n = 4), CDA was additionally associated with oppositional defiant problems (ß = .35; 95% confidence interval 0.02 to 0.69). Associations were not explained by gastrointestinal complaints. CONCLUSIONS: Our results reveal that CDA, especially combined with the HLA-DQ2 and HLA-DQ8 risk alleles, is associated with anxiety problems and oppositional defiant problems. Further research should be used to establish whether behavioral problems are a reflection of subclinical CeD.
Asunto(s)
Ansiedad/inmunología , Déficit de la Atención y Trastornos de Conducta Disruptiva/inmunología , Enfermedades Autoinmunes/psicología , Enfermedad Celíaca/inmunología , Enfermedad Celíaca/psicología , Autoanticuerpos/sangre , Enfermedades Autoinmunes/sangre , Enfermedades Autoinmunes/genética , Enfermedad Celíaca/sangre , Enfermedad Celíaca/diagnóstico , Lista de Verificación , Niño , Preescolar , Intervalos de Confianza , Femenino , Proteínas de Unión al GTP/inmunología , Antígenos HLA-DQ/sangre , Antígenos HLA-DQ/genética , Humanos , Lactante , Modelos Lineales , Masculino , Problema de Conducta/psicología , Estudios Prospectivos , Proteína Glutamina Gamma Glutamiltransferasa 2 , Sensibilidad y Especificidad , Factores Sexuales , Transglutaminasas/inmunologíaAsunto(s)
Terapias Complementarias , Modas Dietéticas , Suplementos Dietéticos , Déficit de la Atención y Trastornos de Conducta Disruptiva/dietoterapia , Déficit de la Atención y Trastornos de Conducta Disruptiva/inmunología , Niño , Desensibilización Inmunológica , Sacarosa en la Dieta , Aceites de Pescado/uso terapéutico , Humanos , Inmunoterapia , Discapacidades para el Aprendizaje/inmunología , Discapacidades para el Aprendizaje/terapia , Terapia Ortomolecular , Zinc/uso terapéuticoRESUMEN
We report on a five year old boy who was admitted to hospital because of obstructive airway disease; initially, findings were interpreted to indicate bronchial asthma. In addition, the patient presented with a behavioural abnormality of aggressiveness and hyperactivity. Laboratory examinations showed an elevated IgE level and eosinophilia, chest x-ray revealed infiltrations in both lungs. After excluding a spectrum of chronic lung disorders by relevant investigations, serological testing for parasitosis revealed massively elevated toxocara IgG antibodies. The diagnosis of a "covert form" of toxocarosis was established and an antihelminthic therapy with albendazole was initiated. Chronic respiratory symptoms in childhood can also indicate the presence of a parasitic infestation.
