Browsing by Subject "coeliac disease"

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  • Hervonen, Kaisa; Salmi, Teea T.; Ilus, Tuire; Paasikivi, Kaija; Vornanen, Martine; Laurila, Kaija; Lindfors, Katri; Viiri, Keijo; Saavalainen, Paivi; Collin, Pekka; Kaukinen, Katri; Reunala, Timo (2016)
    Dermatitis herpetiformis (DH) is a blistering skin disease, which is regarded as an extra-intestinal manifestation of coeliac disease. Refractory cases of coeliac disease, that do not respond to a gluten-free diet and which carry an increased risk of lymphoma, are well-known in coeliac disease. To determine whether refractory cases of DH with active rash and persistent small bowel atrophy occur we analysed our series of 403 patients with DH. Seven (1.7%) patients, who had been on a gluten-free diet for a mean of 16 years, but who still required dapsone to treat the symptoms of DH, were identified. Of these, one patient died from mucinous adenocarcinoma before re-examination. At re-examination skin immunoglobulin A (IgA) deposits were found in 5/6 refractory and 3/16 control DH patients with good dietary response. Small bowel mucosa was studied at re-examination from 5 refractory and 8 control DH patients and was normal in all 5 refractory and 7/8 control DH patients. One refractory DH patient died from adenocarcinoma, but no lymphoma developed in any of the patients. This study documents for the first time refractory DH, in which the rash is non-responsive to a gluten-free diet, but the small bowel mucosa heals. This differs from refractory coeliac disease, in which the small bowel mucosa does not heal on a gluten-free diet.
  • The TEDDY Study Group; Lindfors, Katri; Lin, Jake; Hyöty, Heikki; Nykter, Matti; Kurppa, Kalle; Liu, Edwin; Koletzko, Sibylle; Rewers, Marian; Hagopian, William; Toppari, Jorma; Ziegler, Annette-Gabriele; Akolkar, Beena; Krischer, Jeffrey P.; Petrosino, Joseph F.; Lloyd, Richard E.; Agardh, Daniel (2020)
    Objective: Higher gluten intake, frequent gastrointestinal infections and adenovirus, enterovirus, rotavirus and reovirus have been proposed as environmental triggers for coeliac disease. however, it is not known whether an interaction exists between the ingested gluten amount and viral exposures in the development of coeliac disease. This study investigated whether distinct viral exposures alone or together with gluten increase the risk of coeliac disease autoimmunity (cDa) in genetically predisposed children. Design: The environmental Determinants of Diabetes in the Young study prospectively followed children carrying the hla risk haplotypes DQ2 and/or DQ8 and constructed a nested case–control design. From this design, 83 cDa case–control pairs were identified. Median age of cDa was 31 months. stool samples collected monthly up to the age of 2 years were analysed for virome composition by illumina next-generation sequencing followed by comprehensive computational virus profiling. Results: The cumulative number of stool enteroviral exposures between 1 and 2 years of age was associated with an increased risk for cDa. in addition, there was a significant interaction between cumulative stool enteroviral exposures and gluten consumption. The risk conferred by stool enteroviruses was increased in cases reporting higher gluten intake. Conclusions: Frequent exposure to enterovirus between 1 and 2 years of age was associated with increased risk of cDa. The increased risk conferred by the interaction between enteroviruses and higher gluten intake indicate a cumulative effect of these factors in the development of cDa.