Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Çölyak Hastalığı Olan Çocukların Kardeşlerinde Çölyak Hastalığı, Çölyak Dışı Gluten Duyarlılığı ve Buğday Alerjisi Sıklığı: Kesitsel Prospektif Çalışma
Prevalence of Celiac Disease, Non-Celiac Gluten Sensitivity, and Wheat Allergy in Siblings of Children with Celiac Disease: Cross-Sectional Prospective Study
Fatma İSSİa, Burcu GÜVENa, Murat ÇAKIRa
aKaradeniz Teknik Üniversitesi Tıp Fakültesi, Çocuk Gastroenteroloji BD, Trabzon, Türkiye
Turkiye Klinikleri J Pediatr. 2022;31(2):101-5
doi: 10.5336/pediatr.2022-88157
Article Language: TR
Full Text
ÖZET
 Çölyak hastalığı (ÇH) genetik olarak yatkın bireylerde, gluten maruziyeti sonrası ince bağırsak mukozal hasarı ile seyreden otoimmün aracılı bir hastalıktır. ÇH olan bireylerin kardeşlerinde ÇH görülme sıklığının, normal popülasyondan daha fazla olduğu bilinmekle beraber çölyak dışı gluten duyarlılığı (ÇDGD) ve buğday alerjisi (BA) sıklığı açısından sınırlı sayıda çalışma mevcuttur. Bu çalışmanın amacı, ÇH olan çocukların kardeşlerinde ÇH, ÇDGD ve BA sıklığını araştırmaktır. Gereç ve Yöntemler: Çocuk gastroenteroloji polikliniğimizde, ÇH nedeniyle takip edilen hastaların kardeşleri ÇH, ÇDGD ve BA açısından tetkik edildi. ÇH tanısı Avrupa Pediatrik Gastroenteroloji, Hepatoloji ve Beslenme Birliği Komitesi kriterlerine göre ÇDGD ise gluten alımıyla ilişkili semptomların gluten eliminasyonuyla düzelmesi ile BA ise buğday ile görülen semptomların, diyetten eliminasyon sonrası kaybolması ve buğday spesifik immünglobulin E'nin tespiti ile konuldu. Olguların demografik ve klinik özellikleri ile laboratuvar parametreleri kaydedildi. Bulgular: Çalışmaya ÇH olan 59 çocuğun dâhil edilme kriterlerini karşılayan 50 kardeşi [25 erkek (%50), yaş ortalaması±standart sapma; 11,5±3,66 yıl (4-17 yıl)] alındı. Kardeşlerin 3'üne [%6, %95 güven aralığı (GA): 1,56-17,54] ÇH, 7'sine (%14, %95 GA: 6,28-27,36) ÇDGD tanısı konuldu. BA hiçbir olguda saptanmadı. Sonuç: Çalışmamızda, ÇH olan çocukların kardeşlerinde hem ÇH sıklığı hem de ÇDGD sıklığı yüksek bulundu. Kardeş taraması yapılırken semptomu olup, seroloji ve endoskopi bulguları normal olan hastalarda ÇDGD araştırılmalıdır.

Anahtar Kelimeler: Çölyak hastalığı; buğday alerjisi; gluten duyarlılığı
ABSTRACT
 Objective: Celiac disease (CD) is an autoimmune-mediated disease characterized by small intestinal mucosal damage after gluten exposure in genetically predisposed individuals. Although it is known that the prevalence of CD in siblings of celiac patients is more common than the normal population, there are limited studies on the frequency of non-celiac gluten sensitivity (NCGS) and wheat allergy (WA). In this study, we aimed to investigate the prevalence of CD, NCGS and WA in siblings of children with CD. Material and Methods: Siblings of patients diagnosed with CD in our pediatric gastroenterology clinic were examined for CD, NCGS and WA. CD diagnosed according to The European Society for Paediatric Gastroenterology Hepatology and Nutrition guideline. NCGS was diagnosed with the disappearance of symptoms related to gluten intake with gluten elimination, while WA was diagnosed with the absence of wheat-related symptoms after wheat removal from the diet and wheat-specific immunoglobulin E assays. Demographic and clinical features and laboratory parameters of the cases were recorded. Results: 50 siblings of 59 celiac patients eligible for the study [25 males (50%), mean age±standard deviation; 11.5±3.66 years (4-17 years)] were included. Three of the siblings [6%, 95% confidence interval (CI): 1.56-17.54) were diagnosed with CD, and 7 (14%, 95% CI: 6.28-27.36) were diagnosed with NCGS. There was no sibling with a diagnosis of WA. Conclusion: In our study, both CD and NCGS were found to have a higher prevalence in siblings of CD patients. When screening siblings of patients with CD, cases with symptoms and normal serology and endoscopy findings should be evaluated for NCGS.

Keywords: Celiac disease; wheat allergy; gluten sensitivity
REFERENCES:
  1. Sharma N, Bhatia S, Chunduri V, Kaur S, Sharma S, Kapoor P, et al. Pathogenesis of celiac disease and other gluten related disorders in wheat and strategies for mitigating them. Front Nutr. 2020;7:6. [Crossref]  [PubMed]  [PMC] 
  2. Taraghikhah N, Ashtari S, Asri N, Shahbazkhani B, Al-Dulaimi D, Rostami-Nejad M, et al. An updated overview of spectrum of gluten-related disorders: clinical and diagnostic aspects. BMC Gastroenterol. 2020;20(1):258. [Crossref]  [PubMed]  [PMC] 
  3. Elli L, Branchi F, Tomba C, Villalta D, Norsa L, Ferretti F, et al. Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity. World J Gastroenterol. 2015;21(23):7110-9. [Crossref]  [PubMed]  [PMC] 
  4. Roszkowska A, Pawlicka M, Mroczek A, Bałabuszek K, Nieradko-Iwanicka B. Non-celiac gluten sensitivity: a review. Medicina (Kaunas). 2019;55(6):222. [Crossref]  [PubMed]  [PMC] 
  5. Hill ID, Fasano A, Guandalini S, Hoffenberg E, Levy J, Reilly N, et al. NASPGHAN clinical report on the diagnosis and treatment of gluten-related disorders. J Pediatr Gastroenterol Nutr. 2016;63(1):156-65. [Crossref]  [PubMed] 
  6. De Re V, Magris R, Cannizzaro R. New insights into the pathogenesis of celiac disease. Front Med (Lausanne). 2017;4:137. [Crossref]  [PubMed]  [PMC] 
  7. Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 2019;7(5):583-613. [Crossref]  [PubMed]  [PMC] 
  8. Czaja-Bulsa G, Bulsa M. What do we know now about IgE-mediated wheat allergy in children? Nutrients. 2017;9(1):35. [Crossref]  [PubMed]  [PMC] 
  9. Mäkelä MJ, Eriksson C, Kotaniemi-Syrjänen A, Palosuo K, Marsh J, Borres M, et al. Wheat allergy in children - new tools for diagnostics. Clin Exp Allergy. 2014;44(11):1420-30. [Crossref]  [PubMed] 
  10. Barbaro MR, Cremon C, Stanghellini V, Barbara G. Recent advances in understanding non-celiac gluten sensitivity. F1000Res. 2018;7:F1000 Faculty Rev-1631. [Crossref]  [PubMed]  [PMC] 
  11. Borrelli DE Andreis F, Schiepatti A, Gibiino G, Fabbri C, Baiardi P, Biagi F. Is it time to rethink the burden of non-coeliac gluten sensitivity? A systematic review. Minerva Gastroenterol (Torino). 2021;10.23736/S2724-5985.21.03077-1. [Crossref] 
  12. Igbinedion SO, Ansari J, Vasikaran A, Gavins FN, Jordan P, Boktor M, et al. Non-celiac gluten sensitivity: All wheat attack is not celiac. World J Gastroenterol. 2017;23(40):7201-10. [Crossref]  [PubMed]  [PMC] 
  13. Escudero-Hernández C, Pe-a AS, Bernardo D. Immunogenetic pathogenesis of celiac disease and non-celiac gluten sensitivity. Curr Gastroenterol Rep. 2016;18(7):36. [Crossref]  [PubMed] 
  14. Catassi C, Elli L, Bonaz B, Bouma G, Carroccio A, Castillejo G, et al. Diagnosis of non-celiac gluten sensitivity (NCGS): the salerno experts' criteria. Nutrients. 2015;7(6):4966-77. [Crossref]  [PubMed]  [PMC] 
  15. Husby S, Koletzko S, Korponay-Szabó I, Kurppa K, Mearin ML, Ribes-Koninckx C, et al. European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J Pediatr Gastroenterol Nutr. 2020;70(1):141-56. [Crossref]  [PubMed] 
  16. Cabanillas B. Gluten-related disorders: Celiac disease, wheat allergy, and nonceliac gluten sensitivity. Crit Rev Food Sci Nutr. 2020;60(15):2606-21. [Crossref]  [PubMed] 
  17. Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Green PH, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16(6):823-36.e2. [Crossref]  [PubMed] 
  18. Dalgic B, Sari S, Basturk B, Ensari A, Egritas O, Bukulmez A, et al; Turkish Celiac Study Group. Prevalence of celiac disease in healthy Turkish school children. Am J Gastroenterol. 2011;106(8):1512-7. Erratum in: Am J Gastroenterol. 2011;106(8):1565. Yaşar, Aslan [corrected to Dogan, Yasar]. [Crossref]  [PubMed] 
  19. Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, et al. Celiac disease: a comprehensive current review. BMC Med. 2019;17(1):142. [Crossref]  [PubMed]  [PMC] 
  20. Singh P, Arora S, Lal S, Strand TA, Makharia GK. Risk of celiac disease in the first- and second-degree relatives of patients with celiac disease: a systematic review and meta-analysis. Am J Gastroenterol. 2015;110(11):1539-48. [Crossref]  [PubMed] 
  21. Doğan Y, Yildirmaz S, Ozercan IH. Prevalence of celiac disease among first-degree relatives of patients with celiac disease. J Pediatr Gastroenterol Nutr. 2012;55(2):205-8. [Crossref]  [PubMed] 
  22. Sahin Y. Celiac disease in children: A review of the literature. World J Clin Pediatr. 2021;10(4):53-71. [Crossref]  [PubMed]  [PMC] 
  23. Ricci G, Andreozzi L, Cipriani F, Giannetti A, Gallucci M, Caffarelli C. Wheat allergy in children: a comprehensive update. medicina (Kaunas). 2019;55(7):400. [Crossref]  [PubMed]  [PMC] 
  24. Pasha I, Saeed F, Sultan MT, Batool R, Aziz M, Ahmed W. Wheat allergy and intolerence; recent updates and perspectives. Crit Rev Food Sci Nutr. 2016;56(1):13-24. [Crossref]  [PubMed] 
  25. Keet CA, Matsui EC, Dhillon G, Lenehan P, Paterakis M, Wood RA. The natural history of wheat allergy. Ann Allergy Asthma Immunol. 2009;102(5):410-5. [Crossref]  [PubMed] 
  26. Lombardi C, Savi E, Passalacqua G. Concomitant celiac disease and wheat allergy: 2 case reports. J Investig Allergol Clin Immunol. 2019;29(6):454-6. [Crossref]  [PubMed] 
  27. Borghini R, Donato G, Marino M, Casale R, Tola MD, Picarelli A. In extremis diagnosis of celiac disease and concomitant wheat allergy. Turk J Gastroenterol. 2018;29(4):515-7. [Crossref]  [PubMed]  [PMC] 
  28. Kreiner E, Waage J, Standl M, Brix S, Pers TH, Couto Alves A, et al. Shared genetic variants suggest common pathways in allergy and autoimmune diseases. J Allergy Clin Immunol. 2017;140(3):771-81. [Crossref]  [PubMed] 
  29. Cárdenas-Torres FI, Cabrera-Chávez F, Figueroa-Salcido OG, Ontiveros N. Non-celiac gluten sensitivity: an update. Medicina (Kaunas). 2021;57(6):526. [Crossref]  [PubMed]  [PMC] 
  30. Camhi SS, Sangal K, Kenyon V, Lima R, Fasano A, Leonard MM. Pediatric nonceliac gluten sensitivity: a gluten-related disorder treatment center experience. J Pediatr Gastroenterol Nutr. 2019;69(2):200-5. [Crossref]  [PubMed] 
  31. Tanpowpong P, Ingham TR, Lampshire PK, Kirchberg FF, Epton MJ, Crane J, et al; New Zealand Asthma and Allergy Cohort Study Group. Coeliac disease and gluten avoidance in New Zealand children. Arch Dis Child. 2012;97(1):12-6. [Crossref]  [PubMed] 
  32. Tanpowpong P, Broder-Fingert S, Katz AJ, Camargo CA Jr. Predictors of gluten avoidance and implementation of a gluten-free diet in children and adolescents without confirmed celiac disease. J Pediatr. 2012;161(3):471-5. [Crossref]  [PubMed] 
  33. Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012;10:13. [Crossref]  [PubMed]  [PMC] 
  34. Schiepatti A, Savioli J, Vernero M, Borrelli de Andreis F, Perfetti L, Meriggi A, et al. Pitfalls in the diagnosis of coeliac disease and gluten-related disorders. Nutrients. 2020;12(6):1711. [Crossref]  [PubMed]  [PMC] 

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