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Patient factors influencing acute gluten reactions and cytokine release in treated coeliac disease1.27 MB
Published VersionCC BY V4.0, Open Access
Journal article
Patient factors influencing acute gluten reactions and cytokine release in treated coeliac disease
BMC Medicine, Vol.18(1), pp.362-362
2020
PMID: 33239013
Abstract
BACKGROUND: Patients with coeliac disease (CD) commonly report a variety of adverse symptoms to gluten, but descriptions of the symptomatic response in the literature may have been confounded by the presence of food components such as fermentable carbohydrates (FODMAPs) causing symptoms of irritable bowel syndrome independent of gluten. In recent unmasked and masked low FODMAP gluten challenge studies in small groups of treated CD patients, nausea and vomiting were shown to be the key symptoms associated with serum interleukin (IL)-2 release. Our objective was to utilise a large and diverse cohort of people with CD undertaking a standardised gluten food challenge to characterise the demographic, genetic and clinical factors influencing the severity and timing of acute gluten reactions and IL-2 production. METHODS: A total of 295 adults treated for CD were observed for 6 h after an unmasked food challenge consisting of 10 g vital wheat gluten (low in FODMAPs) in 100 ml water. Assessments included patient-reported outcomes, serum IL-2 and adverse events. Responses were analysed according to patient characteristics, HLA-DQ genotype, duodenal histology and response to a second gluten challenge. RESULTS: Peak symptom severity was at 3 h (median severity 5/10). Peak IL-2 was at 4 h (median 4 pg/ml, range undetectable to 1028 pg/ml). Older age, older age at diagnosis, HLA-DQ2.5 positivity and homozygosity for HLA-DQB1*02 were each significantly associated with IL-2 elevations after gluten. Patients positive for HLA-DQ2.5, DQ8, DQ2.2 or DQ7 showed elevated IL-2 after gluten. Patient factors were not significantly associated with severity of digestive symptoms, but symptoms were correlated to one another and serum IL-2. Gluten challenge after 5 months caused more vomiting and higher IL-2 levels, but responses correlated with the first. CONCLUSIONS: Gluten-induced symptoms and cytokine release is common in adults with treated CD. Age, genetics and previous response to gluten predict these acute reactions to gluten challenge. Structured symptom assessment and serum IL-2 after standardised gluten challenge may inform on patient diagnosis, the role of gluten in symptomatology and the need for adjunctive treatment.
Details
- Title
- Patient factors influencing acute gluten reactions and cytokine release in treated coeliac disease
- Authors
- Jason A Tye-Din (Author) - The University of MelbourneA James M Daveson (Author) - The University of QueenslandKaela E Goldstein (Author) - ImmusanT Inc.Holly L Hand (Author) - ImmusanT Inc.Kristin M Neff (Author) - ImmusanT Inc.Gautam Goel (Author) - ImmusanT Inc.Leslie J Williams (Author) - ImmusanT Inc.Kenneth E Truitt (Author) - ImmusanT Inc.Robert P Anderson (Author) - ImmusanT Inc.RESET CeD Study Group (Author)Susan Thackwray (Group Member) - University of the Sunshine Coast, Queensland, School of Health and Sport Sciences - Legacy
- Publication details
- BMC Medicine, Vol.18(1), pp.362-362
- Publisher
- BioMed Central Ltd.
- Date published
- 2020
- DOI
- 10.1186/s12916-020-01828-y
- ISSN
- 1741-7015; 1741-7015
- PMID
- 33239013
- Copyright note
- © The Author(s). 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
- Organisation Unit
- School of Science and Engineering - Legacy; University of the Sunshine Coast, Queensland; School of Health and Sport Sciences - Legacy
- Language
- English
- Record Identifier
- 99489706402621
- Output Type
- Journal article
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