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Vajpayee S, Sharma SD, Gupta R, Goyal A, Sharma A. Early Infant Feeding Practices May Influence the Onset of Symptomatic Celiac Disease. Pediatr Gastroenterol Hepatol Nutr 2016; 19:229-235. [PMID: 28090467 PMCID: PMC5234418 DOI: 10.5223/pghn.2016.19.4.229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/17/2016] [Accepted: 10/01/2016] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To study whether breastfeeding and breastfeeding status during gluten introduction influences the age at diagnosis of celiac disease (CD). In addition to study, whether the timing of gluten introduction influences the age at diagnosis of CD. METHODS It was a hospital based observational study. Total 198 patients diagnosed with CD as per modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition (2012) criteria, aged between 6 months to 6 years were included. Detail history taken with special emphasis on breastfeeding and age of gluten introduction. Standard statistical methods used to analyze the data. RESULTS Mean±standard deviation age of onset and diagnosis of CD in breastfed cases was 2.81±1.42 years and 3.68 ±1.55 years respectively as compared to 1.84±1.36 years and 2.70±1.65 years respectively in not breastfed cases (p<0.05). Those who had continued breastfeeding during gluten introduction and of longer duration had significantly delayed onset of disease. The age at onset of CD was under one year in 40.42% of the cases, who had started gluten before 6 months of age compared to only 12.58% of those who had started gluten later (p<0.001). The proposed statistical model showed that two variables, i.e., breast feeding status during gluten introduction and age at gluten introduction positively influencing the age at diagnosis of CD. CONCLUSION Delayed gluten introduction to infant's diet along with continuing breastfeeding, delays symptomatic CD. However, it is not clear from our study that these infant feeding practices provide permanent protection against the disease or merely delays the symptoms.
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Affiliation(s)
- Shailja Vajpayee
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| | - Shiv Dayal Sharma
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| | - Rajkumar Gupta
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| | - Alok Goyal
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| | - Aakash Sharma
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
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Jorgensen GH, Ornolfsson AE, Johannesson A, Gudmundsson S, Janzi M, Wang N, Hammarström L, Ludviksson BR. Association of immunoglobulin A deficiency and elevated thyrotropin-receptor autoantibodies in two Nordic countries. Hum Immunol 2010; 72:166-72. [PMID: 20977916 DOI: 10.1016/j.humimm.2010.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/29/2010] [Accepted: 10/19/2010] [Indexed: 01/01/2023]
Abstract
Immunoglobulin A deficiency (IgAD) is the most common primary immunodeficiency, with suggested association with various types of autoimmunity, including Graves' disease. This study investigated the association of IgAD with elevated thyrotropin-receptor autoantibodies (TRAb). IgA was measured in TRAb-seropositive individuals from both Iceland (N = 299] and Sweden (N = 841]. In addition, TRAb levels were evaluated in 43 Icelandic and 50 Swedish IgAD individuals using Medizym TRA immunoassay, and positive samples were re-evaluated using BRAHMS TRAK human RIA. The IgAD individuals were HLA-genotyped to determine the HLA-B, DR, and DQ alleles. None of the 299 Icelandic TRAb-seropositive individuals had IgAD, whereas, a high prevalence of IgAD (14/841 (1:60)) was observed in the Swedish cohort (p = 0.027). The prevalence of TRAb-seropositivity in IgAD individuals was, however, increased in both cohorts. The HLA-DQ6 allele was associated with TRAb-seronegativity within the Icelandic IgAD cohort (p = 0.037). The prevalence of IgAD in TRAb-seropositive individuals in Sweden is 10 times higher than expected in the general population. Furthermore, TRAb seropositivity is common among IgAD individuals, both in Iceland and Sweden, suggesting a predisposition toward Graves' disease. These findings underline the significant association of IgAD with autoimmunity and its possible association with certain HLA-DQ alleles.
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Kondrashova A, Mustalahti K, Kaukinen K, Viskari H, Volodicheva V, Haapala AM, Ilonen J, Knip M, Mäki M, Hyöty H. Lower economic status and inferior hygienic environment may protect against celiac disease. Ann Med 2008; 40:223-31. [PMID: 18382888 DOI: 10.1080/07853890701678689] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The populations in adjacent Russian Karelia and Finland are equally exposed to grain products and share partly the same ancestry, but live in completely different socioeconomic environments. AIM This creates an ideal epidemiological setting to study gene-environmental interactions in pathogenesis of celiac disease. METHODS The prevalence of celiac disease and predisposing human leukocyte antigen (HLA) alleles was compared between Russian Karelia and Finland. Tissue transglutaminase antibodies and HLA-DQ alleles were screened from 1988 schoolchildren from Karelia and 3654 children from Finland. Children with transglutaminase antibodies were invited to small-bowel biopsy. Results. Transglutaminase antibodies were less frequent in Russian Karelia than in Finland (0.6% versus 1.4%, P = 0.005). Immunoglobulin class G (IgG) antigliadin antibodies were also less frequent in Russian Karelia (10.2% versus 28.3%, P<0.0001). Celiac disease was confirmed by duodenal biopsy in four of the eight transglutaminase antibody-positive Karelian children, giving a prevalence of 1 in 496 compared to 1 in 107 children in Finland. The same HLA-DQ alleles were associated with celiac disease and transglutaminase antibody positivity in both populations. CONCLUSIONS The prevalence of transglutaminase antibodies and celiac disease is lower in Russian Karelia than in Finland. This may be associated with a protective environment characterized by inferior prosperity and standard of hygiene in Karelia.
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Affiliation(s)
- Anita Kondrashova
- Department of Virology, University of Tampere, Medical School, Tampere, Finland
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Hopkinson JM. Response to "is breast really best? Risk and total motherhood in the National Breastfeeding Awareness Campaign". JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2007; 32:637-48; discussion 649-54. [PMID: 17639014 DOI: 10.1215/03616878-2007-019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Pastorello EA, Farioli L, Conti A, Pravettoni V, Bonomi S, Iametti S, Fortunato D, Scibilia J, Bindslev-Jensen C, Ballmer-Weber B, Robino AM, Ortolani C. Wheat IgE-mediated food allergy in European patients: alpha-amylase inhibitors, lipid transfer proteins and low-molecular-weight glutenins. Allergenic molecules recognized by double-blind, placebo-controlled food challenge. Int Arch Allergy Immunol 2007; 144:10-22. [PMID: 17496422 DOI: 10.1159/000102609] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 02/21/2007] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Three main problems hamper the identification of wheat food allergens: (1) lack of a standardized procedure for extracting all of the wheat protein fractions; (2) absence of double-blind, placebo-controlled food challenge studies that compare the allergenic profile of Osborne's three protein fractions in subjects with real wheat allergy, and (3) lack of data on the differences in IgE-binding capacity between raw and cooked wheat. METHODS Sera of 16 wheat-challenge-positive patients and 6 patients with wheat anaphylaxis, recruited from Italy, Denmark and Switzerland, were used for sodium dodecyl sulfate-polyacrylamide gel electrophoresis/immunoblotting of the three Osborne's protein fractions (albumin/globulin, gliadins and glutenins) of raw and cooked wheat. Thermal sensitivity of wheat lipid transfer protein (LTP) was investigated by spectroscopic approaches. IgE cross-reactivity between wheat and grass pollen was studied by blot inhibition. RESULTS The most important wheat allergens were the alpha-amylase/trypsin inhibitor subunits, which were present in all three protein fractions of raw and cooked wheat. Other important allergens were a 9-kDa LTP in the albumin/globulin fraction and several low-molecular-weight (LMW) glutenin subunits in the gluten fraction. All these allergens showed heat resistance and lack of cross-reactivity to grass pollen allergens. LTP was a major allergen only in Italian patients. CONCLUSIONS The alpha-amylase inhibitor was confirmed to be the most important wheat allergen in food allergy and to play a role in wheat-dependent exercise-induced anaphylaxis, too. Other important allergens were LTP and the LMW glutenin subunits.
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Affiliation(s)
- Elide A Pastorello
- Unit of Allergology and Clinical Immunology, Niguarda Cà Granda Hospital, Milan, Italy.
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Chertok IR. The importance of exclusive breastfeeding in infants at risk for celiac disease. MCN Am J Matern Child Nurs 2007; 32:50-4; quiz 55-6. [PMID: 17308459 DOI: 10.1097/00005721-200701000-00011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article presents a review of studies examining the association between breastfeeding and delayed symptomatic celiac disease and provides implications for practice. Celiac disease is a chronic intestinal disease involving intolerance to gluten. Symptomatic celiac disease varies in presentation and may include malabsorption, diarrhea, steatorrhea, and malnutrition. Its etiology is multifactorial, related to genetic susceptibility and exposure to gluten. Exclusive breastfeeding, with its many health benefits, may mitigate or delay symptomatic celiac disease. Because infants with a positive family history of the disease could be affected, it is crucial to identify those at risk and educate and advise parents regarding the importance of exclusive breastfeeding.
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Affiliation(s)
- Ilana R Chertok
- West Virginia University, School of Nursing, Morgantown, USA.
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Akobeng AK, Ramanan AV, Buchan I, Heller RF. Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies. Arch Dis Child 2006; 91:39-43. [PMID: 16287899 PMCID: PMC2083075 DOI: 10.1136/adc.2005.082016] [Citation(s) in RCA: 210] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coeliac disease (CD) is a disorder that may depend on genetic, immunological, and environmental factors. Recent observational studies suggest that breast feeding may prevent the development of CD. AIM To evaluate articles that compared effects of breast feeding on risk of CD. METHODS Systematic review and meta-analysis of observational studies published between 1966 and June 2004 that examined the association between breast feeding and the development of CD. RESULTS Six case-control studies met the inclusion criteria. With the exception of one small study, all the included studies found an association between increasing duration of breast feeding and decreased risk of developing CD. Meta-analysis showed that the risk of CD was significantly reduced in infants who were breast feeding at the time of gluten introduction (pooled odds ratio 0.48, 95% CI 0.40 to 0.59) compared with infants who were not breast feeding during this period. CONCLUSIONS Breast feeding may offer protection against the development of CD. Breast feeding during the introduction of dietary gluten, and increasing duration of breast feeding were associated with reduced risk of developing CD. It is, however, not clear from the primary studies whether breast feeding delays the onset of symptoms or provides a permanent protection against the disease. Long term prospective cohort studies are required to investigate further the relation between breast feeding and CD.
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Affiliation(s)
- A K Akobeng
- Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, Central Manchester, Manchester, UK.
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D'Amico MA, Holmes J, Stavropoulos SN, Frederick M, Levy J, DeFelice AR, Kazlow PG, Green PHR. Presentation of pediatric celiac disease in the United States: prominent effect of breastfeeding. Clin Pediatr (Phila) 2005; 44:249-58. [PMID: 15821850 DOI: 10.1177/000992280504400309] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Childhood celiac disease (CD) is considered rare in the United States. Consequently there are few data concerning its clinical presentation. A validated questionnaire was distributed to families of children with CD. One hundred forty-one children with biopsy-proven CD were included in the study. We found significant differences in the clinical spectrum of children based on their infant feeding history. Exclusively breastfed children were significantly less likely to report failure to thrive (69% vs 88%, p<0.05) and short stature (37% vs 62%, p<0.05), and had a higher rate of "atypical'' symptoms (p<0.01). Breastfeeding alters the presentation and contributes to atypical presentations of CD and diagnostic delay. Pediatricians need to be aware of the diverse manifestations of celiac disease to reduce diagnostic delay.
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Affiliation(s)
- Michael A D'Amico
- Department of Medicine, and the Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
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La Villa G, Pantaleo P, Tarquini R, Cirami L, Perfetto F, Mancuso F, Laffi G. Multiple immune disorders in unrecognized celiac disease: a case report. World J Gastroenterol 2003; 9:1377-80. [PMID: 12800261 PMCID: PMC4611821 DOI: 10.3748/wjg.v9.i6.1377] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We reported a female patient with unrecognized celiac disease and multiple extra intestinal manifestations, mainly related to a deranged immune function, including macroamilasemia, macrolipasemia, IgA nephropathy, thyroiditis, and anti-b2-glicoprotein-1 antibodies, that disappeared or improved after the implementation of a gluten-free diet.
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Affiliation(s)
- Giorgio La Villa
- Dipartimento di Medicina Interna, Università degli Studi di Firenze, Firenze, Italy
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Abstract
Celiac disease remains a challenge to the clinician and scientist. It is clearly more prevalent than was previously suspected. Much interest is seen in identifying the genetic factors, which predispose to disease and the environmental agents that can trigger it. Genome-wide searches have identified a number of chromosomal susceptibility loci. Specific gliadin epitopes are being analyzed. New diagnostic options include the tissue transglutaminase enzyme-linked immunosorbent assay. Neurologic disease and bone disease are intriguing complications of celiac disease and are gradually being defined.
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Affiliation(s)
- Jason S R Jennings
- Academic Unit of General Surgery, Medicine, and Anaesthesia, St. James's University Hospital, Leeds, United Kingdom.
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Abstract
The aim of this review was to identify if exclusive breast-feeding reduced the risk of coeliac disease (CD) in children. Medline, Embase and CINAHL databases were searched for cohort studies and case control studies that compared exclusive breast-feeding rates with formula or mixed (breast and formula) of the same duration. Three case control studies met the review criteria and were included in the review. The results from these studies show that there is a reduced risk in the onset of CD in those children who were exclusively breast-fed compared to those who were not. However, the design of these studies did not allow a causal relationship to be established. The evidence from these studies suggests a delay in the onset of CD in breast-fed children, however it cannot be ruled out that breast-feeding continues to have a protective factor in adolescence and adulthood. The exact role of breast-feeding in CD prevention needs to be clarified: is it a protective factor against CD, or does it delay the appearance of clinical symptoms? Parents should continue to be encouraged and supported with breast-feeding, as it is the best form of infant nutrition and protective against short and long-term health outcomes.
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