Coincidence of Celiac Disease and Gluten Allergy

Background: The type I or IV of hypersensitivity reactions according to Gell and Coombs classification may be responsible for clinical symptoms observed after ingestion of gluten - containing products. The mechanisms of these reactions are both IgE-dependent or IgE-independent. Celiac disease based on IgE-independent mechanism is classified as gluten hypersensitivity. Clinical manifestation of celiac disease and gluten allergy is often similar. Correct diagnosis of this diseases is particularly important due to the different long-term therapeutic procedures. We wuold like to asses of the incidence of celiac disease in children with gluten allergy.

 Methods: The study involved 50 children with abdominal pain, chronic diarrhea, recurrent respiratory and ears inflammation and skin lesions - the patients of Immunological and Gastroenterology Outpatient Clinic of Institute of Mother and Child. The allergy to gluten was confirmed on the basis of positive peripheral blood lymphocytes blast transformation test and detection of allergen-specific IgE antibodies to gluten (f79). In all children plasma concentration of immunoglobulin classes A, G M and IgA or IgG antibodies against tissue transglutaminase (tTGA) were measured.

Results: In children on the study group the type IV of hypersensitivity reaction to gluten was diagnosed. In 3 children specific IgE antibodies to gluten was also confirmed (f79 - I type hypersensitivity). Anti-tissue transglutaminase antibodies both IgA and IgG were detected in 2 children in whom the concentration of IgA and IgG in serum remained within normal range for age. In these children celiac disease was confirmed by jejunal biopsy.

 Conclusions: 1.The predominant frequency of type IV of hypersensitivity reactions in children in response to the gluten antigen should be taken into account in diagnosis of food allergy. 2. In children diagnosed with gluten allergy the test for celiac disease should be performed.