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1.
Int Arch Allergy Immunol ; 180(4): 250-254, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31522183

RESUMO

INTRODUCTION: Chronic spontaneous urticaria (CSU) in childhood affects the quality of life of the patient and may be associated with other autoimmune diseases. The aim of this study was to investigate the association of autoimmune diseases with CSU in children. METHODS: In a 3-year period, from 2015 to 2018, forty-nine children were diagnosed with CSU and monitored in the Outpatient Pediatric Allergy Clinic of the University Hospital of Ioannina in Northwestern Greece. The comorbidity with other autoimmune diseases was investigated in this population by autoantibody evaluation. RESULTS: Of the 49 children with CSU, 1 had autoantibodies for celiac disease (CD), which was confirmed by duodenal biopsy via gastroscopy. Four children had high serum levels of anti-thyroid peroxidase antibodies but normal thyroid function. No other specific autoantibodies were detected. CONCLUSION: The prevalence of autoimmune diseases among our children with CSU was low. Nevertheless, we think it is important to test children with CSU for other autoimmune diseases. CD can be diagnosed in children with CSU even in the absence of other indicative signs.


Assuntos
Autoanticorpos/sangue , Doenças Autoimunes/imunologia , Doença Celíaca/sangue , Imunoglobulina E/sangue , Adolescente , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Criança , Pré-Escolar , /patologia , Comorbidade , Feminino , Humanos , Lactente , Masculino , Mastócitos/imunologia
2.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31492765

RESUMO

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.


Assuntos
Ansiedade/imunologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/imunologia , Doenças Autoimunes/psicologia , Doença Celíaca/imunologia , Doença Celíaca/psicologia , Autoanticorpos/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/genética , Doença Celíaca/sangue , Doença Celíaca/diagnóstico , Lista de Checagem , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Proteínas de Ligação ao GTP/imunologia , Antígenos HLA-DQ/sangue , Antígenos HLA-DQ/genética , Humanos , Lactente , Modelos Lineares , Masculino , Comportamento Problema/psicologia , Estudos Prospectivos , Sensibilidade e Especificidade , Fatores Sexuais , Transglutaminases/imunologia
3.
Medicina (Kaunas) ; 55(7)2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31277328

RESUMO

Background and objective: Often micronutrient deficiencies cannot be detected when patient is already following a long-term gluten-free diet with good compliance (LTGFDWGC). The aim of this narrative review is to evaluate the most recent literature that considers blood micronutrient deficiencies in LTGFDWGC subjects, in order to prepare dietary supplementation advice (DSA). Materials and methods: A research strategy was planned on PubMed by defining the following keywords: celiac disease, vitamin B12, iron, folic acid, and vitamin D. Results: This review included 73 studies. The few studies on micronutrient circulating levels in long-term gluten-free diet (LTGFD) patients over 2 years with good compliance demonstrated that deficiency was detected in up to: 30% of subjects for vitamin B12 (DSA: 1000 mcg/day until level is normal, then 500 mcg), 40% for iron (325 mg/day), 20% for folic acid (1 mg/day for 3 months, followed by 400-800 mcg/day), 25% for vitamin D (1000 UI/day or more-based serum level or 50,000 UI/week if level is <20 ng/mL), 40% for zinc (25-40 mg/day), 3.6% of children for calcium (1000-1500 mg/day), 20% for magnesium (200-300 mg/day); no data is available in adults for magnesium. Conclusions: If integration with diet is not enough, starting with supplements may be the correct way, after evaluating the initial blood level to determine the right dosage of supplementation.


Assuntos
Doença Celíaca/dietoterapia , Dieta Livre de Glúten/efeitos adversos , Micronutrientes/análise , Adolescente , Adulto , Cálcio/análise , Cálcio/sangue , Doença Celíaca/sangue , Doença Celíaca/tratamento farmacológico , Criança , Dieta Livre de Glúten/métodos , Suplementos Nutricionais/normas , Feminino , Ácido Fólico/análise , Ácido Fólico/sangue , Humanos , Ferro/análise , Ferro/sangue , Masculino , Micronutrientes/sangue , Cooperação do Paciente/psicologia , Vitamina B 12/análise , Vitamina B 12/sangue , Vitamina D/análise , Vitamina D/sangue , Zinco/análise , Zinco/sangue
4.
Oxid Med Cell Longev ; 2019: 7384193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31320984

RESUMO

Neutrophil-to-lymphocyte ratio (NLR) has been proposed as a bone loss index in postmenopausal women and as a marker of inflammation in coeliac patients. The aims of this work were to evaluate the effect of gluten-free diet (GFD) on NLR retrospectively and study the relationship between NLR and Mediterranean diet adherence and selected food groups (fruits, vegetables, red meat, potatoes, and unrefined and refined cereals). Adult individuals (n = 50), who had been on a strict GFD by at least 6 months, were recruited. The degree of adherence to the Mediterranean diet was calculated with two different scores: the Mediterranean Diet Score (MDS-14), assessed through the validated 14-item questionnaire of the PREDIMED study, and the MEDScore (Score-55) proposed by Panagiotakos. The latter includes the consumption of unrefined cereals (UC). High percentages of osteopenia and osteoporosis were found within the recruited subjects, who furnished the reports of bone mineral density (BMD), in particular in postmenopausal (Post-M) women. Recent NLR was higher in subjects with osteoporosis compared to osteopenia and normal BMD. However, retrospective analysis showed both increase and decrease in NLR after GFD, with no significant differences between Marsh grade, anemia, and BMD status. Moreover, premenopausal previous pregnancy (Pre-MPP) and Post-M had higher NLR at diagnosis compared to Men and premenopausal (Pre-M), but higher differences were observed in recent NLR between Pre-MPP and Men only. Chocolate consumption was associated with lower recent NLR, whereas the latter was correlated with Score-55, but not with MDS-14. Moreover, refined cereal consumption was correlated with recent NLR. Although large prospective studies are needed in order to clarify the relationship between UC and NLR in coeliac patients, in this pilot study, we have investigated for the first time the relationship between NLR, dietary habit, and osteoporosis in coeliac disease.


Assuntos
Doença Celíaca/sangue , Doença Celíaca/dietoterapia , Dieta Mediterrânea , Linfócitos/metabolismo , Neutrófilos/metabolismo , Adulto , Doença Celíaca/patologia , Feminino , Humanos , Masculino , Projetos Piloto
5.
Arab J Gastroenterol ; 20(2): 95-98, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31182344

RESUMO

BACKGROUND AND STUDY AIMS: Juvenile idiopathic arthritis (JIA) is characterized by autoimmune aetiology. A gene locus 4q27 related to rheumatoid arthritis, psoriatic arthritis, and coeliac disease is associated with susceptibility to JIA. There are reports indicating several patients with JIA had been diagnosed with CD. We aimed to assess the frequency of coeliac disease (CD) in patients with juvenile idiopathic arthritis (JIA). PATIENTS AND METHODS: This prospective study was carried out from October 2015 to August 2016 and included 96 patients with JIA. All patients were evaluated in terms of clinical and laboratory findings of CD. Levels of total IgA and tissue transglutaminase antibody (tTG) IgA were measured in all patients. Those with increased level of tTG IgA were further tested for anti-endomysium IgA antibodies (EMA). Gastroduodenoscopy were planned for a definite diagnosis of CD in patients with positive EMA. RESULTS: Of the 96 patients in our study, 34 (35.4%) had oligoarticular form of JIA, 29 (30.2%) had polyarticular form, 12 (12.5%) had ERA form, 11 (11.5%) had systemic form, and 10 (10.4%) had psoriatic form. Sixteen of our patients (16.6%) were not using any drugs during the study. Neither EMA IgA antibodies were analysed nor gastro-duodenoscopy was performed because no patients were positive for tTG IgA. There was no difference in terms of tTG levels between the patients using NSAIDs or other drugs. CONCLUSION: We did not find CD in children with JIA. Long term studies with more JIA patients are needed to provide more precise interpretation.


Assuntos
Artrite Juvenil/epidemiologia , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Adolescente , Artrite Juvenil/sangue , Artrite Juvenil/tratamento farmacológico , Doença Celíaca/sangue , Criança , Comorbidade , Feminino , Proteínas de Ligação ao GTP/imunologia , Humanos , Imunoglobulina A/sangue , Incidência , Masculino , Estudos Prospectivos , Transglutaminases/imunologia , Turquia/epidemiologia
6.
BMC Gastroenterol ; 19(1): 91, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196071

RESUMO

BACKGROUND: Celiac disease (CD) is triggered by gluten and related prolamines in genetically susceptible individuals. We aimed to investigate the influence of HLA-DQ genotypes in clinical, serological and histological features related to CD. METHODS: A retrospective observational study was performed including 463 Spanish patients with biopsy-proven CD. Clinical, serological, histological and HLA-DQ genetic data were collected from each participant. The presence of a family history of CD was also considered. Bivariate (chi-square tests or the Fisher's exact test) and multivariate (logistic regression after adjusting for age and sex) analyses were performed to assess the association between clinical and laboratory parameters with HLA-DQ. RESULTS: A predominance of females (62%), classical clinical presentation (86%) and positive anti-transglutaminase 2/endomysium antibodies (99%) was observed in our sample, with a mean age at onset of 2.6 ± 0.1 years. Five percent of our patients were first-degree relatives of subjects with CD, with HLA-DQ genetics showing increased homozygosity of HLA-DQ2.5 (p = 0.03) and HLA-DQ8 (p = 0.09). In the non-CD family history group, an association between delayed disease onset and HLA-DQ8 carriage was observed (p < 0.001), besides an influence of HLA-DQB1*02 gene dosage on clinical presentation and severity of histological damage (after adjusting for age and sex, p = 0.05 and p = 0.02, respectively) and a trend towards presence of specific antibodies (p = 0.09). These associations could not be evaluated properly in the group of patients with affected first-degree relatives due to the small sample size. CONCLUSIONS: HLA-DQ genotypic frequencies differ slightly between CD patients depending on their family history of CD. In patients lacking CD first-degree relatives, carriage of HLA-DQ2.5 with double dose of HLA-DQB1*02 seems to be associated with classical clinical presentation and more severe histological damage.


Assuntos
Doença Celíaca/sangue , Doença Celíaca/genética , Antígenos HLA-DQ/sangue , Índice de Gravidade de Doença , Autoanticorpos/sangue , Autoanticorpos/imunologia , Doença Celíaca/imunologia , Pré-Escolar , Feminino , Proteínas de Ligação ao GTP/imunologia , Predisposição Genética para Doença , Genótipo , Antígenos HLA-DQ/imunologia , Homozigoto , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Estudos Retrospectivos , Transglutaminases/imunologia
7.
Medicina (Kaunas) ; 55(5)2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31096650

RESUMO

Background and objectives: Dermatitis herpetiformis (DH) is a blistering dermatosis, which shares common immunologic features with celiac disease (CD). The aim of the present study was to explore the performance of a panel of CD-related antibodies and IL-17A in Bulgarian patients with DH. Materials and Methods: Serum samples from 26 DH patients at mean age 53 ± 15 years and 20 healthy controls were assessed for anti-tissue transglutaminase (anti-tTG), anti-deamidated gliadin peptides (anti-DGP), anti-actin antibodies (AAA), and IL-17A by enzyme linked immuno-sorbent assay (ELISA), as well as anti-tTG, anti-gliadin (AGA), and anti-Saccharomyces cerevisiae antibodies (ASCA) using immunoblot. Results: The average serum levels of anti-tTG, anti-DGP, AGA, AAA, and the cytokine IL-17A were at significantly higher levels in patients with DH compared to the average levels in healthy persons which stayed below the cut-off value (p < 0.05). Anti-DGP and anti-tTG antibodies showed the highest diagnostic sensitivity and specificity, as well as acceptable positive and negative predictive value. None of the healthy individuals was found positive for the tested antibodies, as well as for ASCA within the DH group. All tests showed good to excellent correlations (r = 0.5 ÷ 0.9, p < 0.01). Conclusions: Although the diagnosis of DH relies on skin biopsy for histology and DIF, serologic testing of a panel of celiac-related antibodies could be employed with advantages in the diagnosing process of DH patients. Furthermore, DH patients who are positive for the investigated serologic parameters could have routine monitoring for gastrointestinal complications typical for the gluten-sensitive enteropathy.


Assuntos
Autoanticorpos/análise , Dermatite Herpetiforme/sangue , Interleucina-17/análise , Adulto , Idoso , Autoanticorpos/sangue , Bulgária , Doença Celíaca/sangue , Estudos Transversais , Feminino , Humanos , Interleucina-17/sangue , Masculino , Pessoa de Meia-Idade
8.
Indian J Med Res ; 149(1): 18-25, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31115370

RESUMO

Background & objectives: : Celiac disease (CD) can exist in various forms in type 1 diabetes (T1D) patients and can remain undetected, leading to severe complications. This study was aimed to evaluate five commercially available anti-tissue transglutaminase (tTG) ELISA kits with distinct formats for the detection of CD and potential CD in T1D patients. Clinical and demographic profiles of the patients with different disease subsets were also studied. Methods: : Fifty T1D patients with classical and non-classical symptoms of CD and 100 T1D patients without any symptoms of CD were included in this study. Anti-tTG autoantibody levels were estimated by five ELISA kits followed by histological examination of duodenal biopsy. HLA DQ2-DQ8 and DRB1-DQB1 typing was done, and serum levels for transforming growth factor (TGF)-ß1 were also estimated. Results: : Assay format detecting anti-tTG IgA antibodies against recombinant antigens along with neopeptides of gliadin was most efficient in the detection of CD in symptomatic patients, and assay format detecting IgA+IgG helped in the detection of potential CD in asymptomatic T1D patients. These findings were supported by histological examination and human leucocyte antigen analysis. Patients with potential CD were found to have markedly deranged glycaemic control parameters and also had significantly raised serum levels of TGF-ß1, (P <0.05) compared to T1D patients. Interpretation & conclusions: : Potential CD can be frequently seen in T1D patients. This can be attributed to the dietary patterns prevalent in the subcontinent and the genetic basis of the disease. Anti-tTG IgA+IgG antibodies can be useful in the detection of these potential CD cases in T1D patients. Early intervention with gluten-free diet can be considered in these patients for better disease management.


Assuntos
Doença Celíaca/sangue , Diabetes Mellitus Tipo 1/sangue , Transglutaminases/isolamento & purificação , Adolescente , Adulto , Anticorpos Anti-Idiotípicos/imunologia , Autoanticorpos/imunologia , Doença Celíaca/complicações , Doença Celíaca/dietoterapia , Doença Celíaca/imunologia , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 1/imunologia , Dieta Livre de Glúten , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoglobulina A/imunologia , Imunoglobulina G/imunologia , Pessoa de Meia-Idade , Fator de Crescimento Transformador beta1/sangue , Transglutaminases/imunologia , Adulto Jovem
9.
Turk J Gastroenterol ; 30(4): 321-325, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30945642

RESUMO

BACKGROUND/AIMS: Celiac disease is an autoimmune, familial disease that results in susceptibility to gluten in cereal and cereal products in genetically susceptible individuals. The aim of the present study was to investigate the presence of HLA-DQ2/DQ8 in patients with celiac disease, their first-degree relatives, and healthy community. MATERIALS AND METHODS: HLA-DQ2/DQ8 analysis was performed in adult patients with celiac disease >18 years old (94 patients), their first-degree relatives (89 people), and healthy group (102 individuals). Anemia, osteoporosis, and diarrhea were interrogated in the celiac patient group and also anti-tissue transglutaminase, anti-endomysium, and anti-gliadin antibodies were recorded. RESULTS: There was a significant relationship between HLA-DQ2/DQ8 presence in all groups, and the distribution of HLA-DQ2/DQ8 in all groups was different (p=0.000). No statistically significant correlation was found between the HLA tissue groups and diarrhea (p=0.087), osteoporosis (p=0.215), anemia (p=1.000), tissue transglutaminase antibodies (p=0.295), anti-gliadin antibodies (p=0.104), and anti-endomysium antibodies (p=0.243) in the celiac patient group. CONCLUSION: HLA-DQ2/DQ8 can be used to diagnose celiac disease particularly when the tests are useless and to screen first-degree relatives.


Assuntos
Autoanticorpos/sangue , Doença Celíaca/sangue , Antígenos HLA-DQ/sangue , Adulto , Autoanticorpos/imunologia , Doença Celíaca/imunologia , Feminino , Gliadina/imunologia , Antígenos HLA-DQ/imunologia , Humanos , Masculino , Linhagem , Transglutaminases/imunologia , Turquia
11.
Gastroenterology ; 157(2): 413-420.e3, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30978358

RESUMO

BACKGROUND & AIMS: Potential celiac disease is characterized by positive results from serologic tests for tissue transglutaminase antibodies (anti-TG2) but normal duodenal architecture (Marsh stages 0-1). There is controversy over the best way to manage these patients. We investigated risk factors associated with the development of villous atrophy in children with potential celiac disease. METHODS: We performed a prospective study of 280 children (ages 2-18 years) in Italy with suspected celiac disease, followed for up to 12 years (range, 18-150 months; median 60 months). The subjects had 2 consecutive positive results from tests for anti-TG2, tested positive for the endomysial antibody (anti-EMA), had total serum levels of immunoglobulin A in the normal range, normal duodenal architecture (Marsh stages 0-1) in 5 biopsies, and HLA DQ2- or DQ8-positive haplotypes. The children underwent serologic tests and clinical analyses every 6 months and a small bowel biopsy was taken every 2 years. A total of 210 patients of the original cohort were assessed at the 9-year follow-up evaluation. We performed multivariate analyses of clinical, genetic, and histologic data to identify factors associated with progression to villous atrophy. RESULTS: During the follow-up period, 42 (15%) of 280 children developed villous atrophy, whereas 89 (32%) children no longer tested positive for anti-TG2 or anti-EMA. The cumulative incidence of progression to villous atrophy was 43% at 12 years. In multivariate analysis, the baseline factors most strongly associated with development of villous atrophy were numbers of γδ intraepithelial lymphocyte cells followed by age and homozygosity for the HLA DQB1*02. In discriminant analysis, these baseline factors identified 80% of the children who developed baseline atrophy. CONCLUSIONS: In a long-term study of 280 children with suspected celiac disease (based on anti-TG2 and anti-EMA) on gluten-containing diets, the cumulative incidence of progression to villous atrophy was 43% over a 12-year period. We identified factors that can be used to identify children at highest risk for villous atrophy. This approach might be used to determine whether children with suspected celiac disease should immediately start a gluten-free diet or be monitored on their regular diet.


Assuntos
Atrofia/patologia , Autoanticorpos/sangue , Doença Celíaca/patologia , Proteínas de Ligação ao GTP/imunologia , Mucosa Intestinal/patologia , Transglutaminases/imunologia , Adolescente , Atrofia/sangue , Atrofia/epidemiologia , Atrofia/imunologia , Autoanticorpos/imunologia , Biópsia , Doença Celíaca/sangue , Doença Celíaca/dietoterapia , Doença Celíaca/imunologia , Criança , Pré-Escolar , Dieta Livre de Glúten , Progressão da Doença , Duodeno , Feminino , Seguimentos , Humanos , Incidência , Itália , Masculino , Estudos Prospectivos
12.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(1): 54-58, abr. 2019. tab
Artigo em Espanhol | LILACS, BDNPAR | ID: biblio-1007956

RESUMO

La enfermedad celíaca (EC) es una enfermedad autoinmune sistémica desencadenada por el consumo de gluten de la dieta en personas con susceptibilidad genética. Los principales test serológicos utilizados para el diagnóstico y seguimiento de la EC son pruebas basadas en anticuerpos de isotipo inmunoglobulina (Ig) A, siendo la determinación de IgA anti-transglutaminasa tisular (tTG)2 la prueba serológica inicial de elección. La deficiencia selectiva de IgA (DSIgA), es más prevalente en pacientes con EC que en la población general, dificultando el diagnostico serológico de la enfermedad. En el presente estudio observacional descriptivo, se incluyeron 74 pacientes adultos con diagnóstico confirmado de EC y se determinó IgA anti-tTG2 en suero mediante ensayo de ELISA a fin de detectar a aquellos pacientes con niveles indeterminados o negativos, los cuales podrían presentar DSIgA. Se dosó IgA total en el suero de estos pacientes por inmunodifusión radial y el promedio fue de 237,8 ± 100,6 mg/dL. En una paciente del sexo femenino fue detectada IgA total menor a 7 mg/dL, con niveles séricos de IgG e IgM normales, característicos de la DSIgA. Así, la frecuencia calculada de DSIgA fue de 1,35% en la población con EC estudiada. En conclusión, este trabajo es una primera aproximación para describir la frecuencia de DSIgA en pacientes con EC del país y reafirma la importancia de incluir el dosaje de IgA total en el caso de realizar test serológicos de la EC basados en IgA(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Imunoglobulina A/sangue , Doença Celíaca/sangue , Deficiência de IgA/sangue , Doença Celíaca/complicações , Doença Celíaca/imunologia , Estudos Transversais , Deficiência de IgA/complicações , Deficiência de IgA/epidemiologia
14.
Acta Gastroenterol Belg ; 82(1): 27-30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30888750

RESUMO

AIM: This study evaluates hepatitis B virus (HBV) vaccination response in children with celiac disease (CD). Response in initial non-responders after a single booster vaccination as well as factors influencing HBV vaccination response were evaluated. METHODOLOGY: Anti-hepatitis B surface antibodies (a-HBsAB) were checked in all children with CD and a documented complete HBV vaccination. An a-HBsAB <10 U/L was considered as non-response. A single intramuscular HBV-vaccine booster was advised to all non-responders. Response was checked at the next appointment. RESULTS: 133 children with CD were included, median age of 7.3 years (range 1.7-17.3) and 46 (35%) were male. The age at CD diagnosis was 6.0 years (range 1.1-15.7). HBV non-response was documented in 55% (n=73/133). No other factors were influencing the response. A booster was documented in 34/73 (47 %) initial non-responders (3 refused (4%), 36 (49%) had no follow up). Response after booster vaccination resulted in immunity in 22/34 (65%) and persisting non-response in 12/34 (35%). A single booster is able to reduce non-response from 55% (73/133) to 23% (22/94). CONCLUSION: A significantly lower immune response following HBV vaccination in children with CD was confirmed. A single intramuscular booster vaccination is able to induce a serologic response in two thirds of the initial non-responders. Control of HBV vaccination response has to become part of the follow-up in CD patients.


Assuntos
Doença Celíaca , Vacinas contra Hepatite B/administração & dosagem , Hepatite B/prevenção & controle , Vacinação/estatística & dados numéricos , Adolescente , Doença Celíaca/sangue , Doença Celíaca/complicações , Doença Celíaca/imunologia , Criança , Pré-Escolar , Hepatite B/complicações , Hepatite B/imunologia , Anticorpos Anti-Hepatite B/análise , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/metabolismo , Antígenos de Superfície da Hepatite B/uso terapêutico , Vacinas contra Hepatite B/metabolismo , Vacinas contra Hepatite B/uso terapêutico , Vírus da Hepatite B , Humanos , Imunidade Ativa/efeitos dos fármacos , Imunização Secundária , Hospedeiro Imunocomprometido/efeitos dos fármacos , Lactente , Masculino , Estudos Prospectivos
15.
Trop Doct ; 49(3): 192-196, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30871417

RESUMO

This study aimed to determine the utility of coeliac serology for monitoring dietary adherence in coeliac disease. Serum anti-tTg IgA and anti-DGP IgG levels of 42 newly diagnosed patients were measured at diagnosis and at intervals of three, six and 12 months after starting a gluten-free diet. Both anti-tTg and anti-DGP antibodies decreased in all patients. The decline in the former was significantly greater at 3-12 months throughout, while in the latter the decline was seen only at three months but not subsequently. Serial measurement of coeliac serology may help in monitoring adherence to a gluten-free diet.


Assuntos
Anticorpos/sangue , Doença Celíaca/sangue , Doença Celíaca/dietoterapia , Dieta Livre de Glúten , Cooperação do Paciente , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Gliadina/imunologia , Humanos , Masculino , Cooperação do Paciente/estatística & dados numéricos , Reprodutibilidade dos Testes , Transglutaminases/imunologia
16.
Int J Clin Pharm ; 41(2): 583-588, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30778740

RESUMO

Background Coeliac disease affects 1% of the population, but 75% remain undiagnosed. Objective To conduct a case finding feasibility and efficacy study for the detection of coeliac disease in community pharmacies. Setting Six community pharmacies across Sheffield, UK. Method A prospective study was performed using a point of care test, Simtomax® (IgA/IgG-deamidated gliadin peptide) (C-test) in pharmacies. Pharmacy customers with symptoms suggestive of or risk factors for coeliac disease were tested with the C-test. Positive individuals were referred for a gastroscopy with duodenal biopsies alongside conventional serology. People with known coeliac disease, those on a gluten free diet or those who were investigated for coeliac disease were excluded. Main outcome measure The case detection rate and the uptake rate of the C-test and gastroscopies. Results Five-hundred participants fulfilled the inclusion criteria and were tested with the C-test (369 females, 73.8%; age range 18-87, median 49). The C-test uptake rate was 63%, and the positive rate was 7.2% (36/500). Twenty-seven positive participants (75%) underwent further investigations, confirming three new cases of coeliac disease (0.6%). Conclusion It was feasible to use the C-test as a case finding tool in pharmacies. There was good uptake for the C-test, although the case detection rate and the test specificity were low. Based on this, the C-test has a limited role in case finding in a community pharmacy setting.


Assuntos
Doença Celíaca/sangue , Doença Celíaca/diagnóstico , Serviços Comunitários de Farmácia/organização & administração , Gliadina/sangue , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade , Adulto Jovem
17.
Front Immunol ; 10: 84, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30804930

RESUMO

Celiac Disease (CD) is a multifactorial, autoimmune enteropathy activated by cereal proteins in genetically predisposed individuals carrying HLA DQ2/8 genes. A heterogenous gene combination of the cereal prolamins is documented in different wheat genotypes, which is suggestive of their variable immunogenic potential. In the current study, four wheat varieties (C591, C273, 9D, and K78) identified via in silico analysis were analyzed for immunogenicity by measuring T-cell proliferation rate and levels of inflammatory cytokines (Interferon-γ and Tumor Necrosis Factor-α). Peripheral Blood Mononuclear Cells and biopsy derived T-cell lines isolated from four CD patients in complete remission and two controls were stimulated and cultured in the presence of tissue transglutaminase activated pepsin-trypsin (PT) digest of total gliadin extract from test varieties. The immunogenicity was compared with PBW 621, one of the widely cultivated wheat varieties. Phytohaemagglutinin-p was taken as positive control, along with unstimulated cells as negative control. Rate of cell proliferation (0.318, 0.482; 0.369, 0.337), concentration of IFN- γ (107.4, 99.2; 117.9, 99.7 pg/ml), and TNF- α (453.8, 514.2; 463.8, 514.2 pg/ml) was minimum in cultures supplemented with wheat antigen from C273, when compared with other test varieties and unstimulated cells. Significant difference in toxicity levels among different wheat genotypes to stimulate celiac mucosal T-cells and PBMC's was observed; where C273 manifested least immunogenic response amongst the test varieties analyzed.


Assuntos
Doença Celíaca/imunologia , Fenômenos Imunogenéticos , Triticum/imunologia , Adolescente , Adulto , Idoso , Biópsia , Doença Celíaca/sangue , Doença Celíaca/patologia , Proliferação de Células , Células Cultivadas , Epitopos de Linfócito T/imunologia , Feminino , Genótipo , Gliadina/isolamento & purificação , Gliadina/metabolismo , Humanos , Interferon gama/sangue , Ativação Linfocitária , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Linfócitos T/imunologia , Linfócitos T/metabolismo , Triticum/classificação , Triticum/genética , Fator de Necrose Tumoral alfa/sangue , Adulto Jovem
18.
Dis Markers ; 2019: 4089178, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30755781

RESUMO

Background and Aims: Rheumatoid arthritis (RA) and celiac disease (CD) are members of the autoimmune disease family while they have been shown to share multiple aspects in epidemiology and clinical manifestations. The aim of this study was to assess the presence of wheat protein antibodies in RA seropositive subjects and the presence of RA diagnostic markers in subjects with seropositive wheat-related disorders including CD. Methods: Serum samples were collected from 844 subjects with joint pain and/or gastrointestinal symptoms and tested by a CD panel (anti-tTG and anti-DGP), a Wheat Zoomer (WZ) antibody panel (IgG/IgA to 14 wheat proteins), and a RA panel (anti-CCP and anti-RF). Retrospective analysis was completed using de-identified clinical data and test results. Results: The prevalence of RA markers was first investigated in CD- or WZ-positive subjects and negative controls. 49 subjects were seropositive in the CD panel with 10 (20%) RA positivity. 605 subjects were seropositive in the WZ panel with 106 (18%) RA positivity. 222 subjects were seronegative in either panels with 12 (6%) RA positivity. Next, the frequency of the CD markers and the clinically relevant wheat protein antibodies were investigated in the RA-positive subjects and negative controls. 128 subjects in this cohort were seropositive in the RA panel with 10 (8%) CD positivity and 106 (83%) WZ positivity, compared to 716 RA seronegative controls with 39 (5%) CD positivity and 499 (70%) WZ positivity. Conclusions: Our data presents an apparent trend of overlapped serological antibody biomarker positivity in RA and wheat-related disorders.


Assuntos
Anticorpos/imunologia , Artrite Reumatoide/imunologia , Doença Celíaca/imunologia , Proteínas de Plantas/imunologia , Adulto , Idoso , Anticorpos/sangue , Artrite Reumatoide/sangue , Biomarcadores/sangue , Doença Celíaca/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Sorológicos/normas , Triticum/química
19.
Nutrients ; 11(1)2019 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-30609862

RESUMO

Coeliac disease (CeD) is an immune-mediated inflammatory enteropathy triggered by the ingestion of gluten in genetically susceptible individuals. Gastrointestinal (GI) hormone response related to appetite and glucose metabolism is still under-investigated in patients with CeD. This study aimed at shedding light on the appetite sensations, glycaemia and hormone response induced by a complex meal in patients with coeliac disease. Twenty-two women with CeD, nine at the diagnosis (CeDD) and thirteen under a gluten-free diet (CeDGF), and ten healthy subjects (HS) were enrolled in a single day intervention study. All subjects consumed a test meal, recorded their appetite sensations, and blood was collected over three hours after meal consumption. The study found a lower decrease in hunger in CeDD compared to CeDGF and HS after meal intake. Data showed no difference of fullness and satiety between the groups. CeDD had lower insulin and glucose-dependent insulinotropic polypeptide (GIP) than CeDGF and HS. Both CeDD and CeDGF experienced a lower post-prandial response of glucose than HS. Data suggested that patients with CeD have an impaired glucose absorption after more than 12 months of gluten-free diet. Postprandial GIP may play a significant role in appetite cues and insulin response to a complex meal.


Assuntos
Apetite , Doença Celíaca/sangue , Dieta Livre de Glúten , Hormônios Gastrointestinais/sangue , Refeições , Adolescente , Adulto , Glicemia , Estudos de Casos e Controles , Doença Celíaca/metabolismo , Feminino , Hormônios Gastrointestinais/metabolismo , Glutens , Humanos , Fome , Período Pós-Prandial , Saciação , Adulto Jovem
20.
Dig Dis Sci ; 64(1): 173-181, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30311156

RESUMO

BACKGROUND/AIMS: The aim of this study was to determine the prevalence of celiac disease (CD) in healthy school-aged children in the northern region of Cyprus and to investigate the existence of potential markers that may accompany CD. This is the first study to measure the prevalence of CD in the northern region of Cyprus. METHODS: This study included 3792 school-aged children who were between the ages of 6 and 10 years between January 2015 and October 2016. CD was screened using total serum IgA, IgA anti-tissue transglutaminase (tTG), and IgA antiendomysial (EMA) antibodies. Subjects with selective IgA deficiency were further tested for IgG-tTG. Small intestinal biopsies were performed on all subjects with tTG antibody positivity. Risk factors and symptoms related to CD were evaluated using questionnaires in both the CD and control groups. RESULTS: Of the 3792 subjects, 39 were antibody positive (IgA-tTG was positive only in 14 subjects, IgA-tTG plus IgA-EMA in 21 subjects, and IgG-tTG in 4 subjects). IgA deficiency was detected in 11 subjects (0.29%). IgG-tTG was positive in 4 subjects with IgA deficiency (36.3%). Intestinal biopsies were performed on 28 of the 39 seropositive subjects. The biopsy findings of 15 children were consistent with CD (IgA-tTG positive in 3, IgA-tTG and IgA-EMA positive in 10, and IgG-tTG positive in 2). Thus, biopsies confirmed CD in 1:256 children (0.39%). CONCLUSIONS: Our study, which is the first study of school-aged children from the northern region of Cyprus, revealed that CD is a prevalent disease in this region.


Assuntos
Doença Celíaca/epidemiologia , Idade de Início , Autoanticorpos/sangue , Biópsia , Estudos de Casos e Controles , Doença Celíaca/sangue , Doença Celíaca/diagnóstico , Doença Celíaca/imunologia , Criança , Chipre/epidemiologia , Feminino , Proteínas de Ligação ao GTP/imunologia , Humanos , Deficiência de IgA/epidemiologia , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Intestino Delgado/patologia , Masculino , Prevalência , Testes Sorológicos , Transglutaminases/imunologia
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