Gluten Challenge Induces Skin and Small Bowel Relapse in Long-Term Gluten-Free Diet-Treated Dermatitis Herpetiformis

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Mansikka , E , Hervonen , K , Kaukinen , K , Ilus , T , Oksanen , P , Lindfors , K , Laurila , K , Hietikko , M , Taavela , J , Jernman , J , Saavalainen , P , Reunala , T & Salmi , T 2019 , ' Gluten Challenge Induces Skin and Small Bowel Relapse in Long-Term Gluten-Free Diet-Treated Dermatitis Herpetiformis ' , Journal of Investigative Dermatology , vol. 139 , no. 10 , pp. 2108-2114 . https://doi.org/10.1016/j.jid.2019.03.1150

Title: Gluten Challenge Induces Skin and Small Bowel Relapse in Long-Term Gluten-Free Diet-Treated Dermatitis Herpetiformis
Author: Mansikka, Eriika; Hervonen, Kaisa; Kaukinen, Katri; Ilus, Tuire; Oksanen, Pia; Lindfors, Katri; Laurila, Kaija; Hietikko, Minna; Taavela, Juha; Jernman, Juha; Saavalainen, Päivi; Reunala, Timo; Salmi, Teea
Contributor: University of Helsinki, Immunobiology Research Program
Date: 2019-10
Language: eng
Number of pages: 7
Belongs to series: Journal of Investigative Dermatology
ISSN: 0022-202X
URI: http://hdl.handle.net/10138/306532
Abstract: Dermatitis herpetiformis (DH) is an extraintestinal manifestation of celiac disease causing an itchy, blistering rash. Granular IgA deposits in the skin are pathognomonic for DH, and the treatment of choice is a lifelong gluten-free diet (GFD). Preliminary evidence suggests that there are patients with DH who redevelop gluten tolerance after adherence to a GFD treatment. To evaluate this, we performed a 12-month gluten challenge with skin and small-bowel mucosal biopsy samples in 19 patients with DH who had adhered to a GFD for a mean of 23 years. Prechallenge biopsy was negative for skin IgA and transglutaminase 3 deposits in 16 patients (84%) and indicated normal villous height-to-crypt depth ratios in the small bowel mucosa in all 19 patients. The gluten challenge caused a relapse of the rash in 15 patients (79%) in a mean of 5.6 months; of these 15 patients, 13 had skin IgA and transglutaminase 3 deposits, and 12 had small-bowel villous atrophy. In addition, three patients without rash or immune deposits in the skin developed villous atrophy, whereas one patient persisted without any signs of relapse. In conclusion, 95% of the patients with DH were unable to tolerate gluten even after long-term adherence to a GFD. Therefore, lifelong GFD treatment remains justified in all patients with DH.
Subject: ANTIEPIDERMAL TRANSGLUTAMINASE ANTIBODIES
2-SPECIFIC IGA DEPOSITS
CELIAC-DISEASE
TISSUE TRANSGLUTAMINASE
FOLLOW-UP
LESIONS
ENTEROPATHY
LYMPHOCYTES
PREVALENCE
GUIDELINES
3121 Internal medicine
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