Research Roundup: February/March 2018
The latest medical news for people with allergies and food sensitivities.
Surprising Sign of Celiac
A case recently published in the Journal of Medical Case Reports described a dramatic and surprising presentation of celiac disease. A 3-year-old Albanian girl came to a clinic with carpal spasms (involuntary muscle contractions) and paresthesia (numbness and tingling) in her hands. A physical exam revealed no other symptoms but a blood test showed the child had severe calcium depletion. A screening for celiac disease was conducted (among other tests) with positive results; the diagnosis was confirmed with a duodenal biopsy.
Low calcium is common in those with untreated celiac disease but carpal spasms as the initial manifestation of the disease is rare. Even without digestive symptoms, “the possibility of celiac disease should be considered in patients with repeated carpal spasms that seem unduly difficult to treat,” the authors concluded.
EoE Risk Factors
Researchers used a registry at Cincinnati Children’s Hospital Medical Center to analyze the importance of early-life environmental factors in the rapidly increasing incidence of pediatric eosinophilic esophagitis (EoE), an allergic condition of the esophagus associated with swallowing difficulty, vomiting, heartburn and more. They found that maternal fever, preterm labor, cesarean delivery, and antibiotic or acid suppressant use during infancy were associated with the risk of developing pediatric EoE. Having a furry pet in the home appeared to be protective. The study was published in The Journal of Allergy and Clinical Immunology.
Antibiotics & Celiac
Does the growing use of antibiotics worldwide contribute to the increased incidence of autoimmune diseases in industrialized countries? A team of researchers set out to answer this question, particularly in regard to type 1 diabetes and celiac disease. Looking at newborns with genetic susceptibilities for these diseases from Finland, Germany, Sweden and the United States, the team found that the risk of developing type 1 diabetes or celiac was not associated with frequency of antibiotic use. The study was published in JAMA Pediatrics.
Celiac Funding Lags
In a commentary published in the journal Gastroenterology, researchers evaluated NIH funding from 2011 through 2015 for celiac disease, irritable bowel syndrome (IBS), Crohn’s disease, eosinophilic esophagitis (EoE), Barrett’s esophagus and non-alcoholic fatty liver disease (NAFLD). Over that period, celiac disease consistently received the lowest amount of NIH funding (about $3 million a year). Crohn’s disease was consistently awarded the highest (about $16 million per year), followed by Barrett’s (about $13 million), NAFLD (about $7 million), IBS (about $5 million) and EoE (about $4 million). The same pattern emerged when researchers looked at the number of grants NIH awarded, with celiac disease receiving the lowest number, about eight grants per year.
There was no association between NIH funding and estimated disease prevalence in the United States. Crohn’s, which has the second lowest prevalence (about 0.25 percent), received the most funding; celiac has a prevalence of 1 percent. Nor was there any relationship between disease mortality rates; celiac disease showed the highest mortality compared to the others.
Authors, including celiac specialists Daniel Leffler, MD, and Sonia Kupfer, MD, called on national authorities to address this inequity and to improve progress across all gastrointestinal diseases.
Celiac & Bone Health
A group of researchers at the University of Catanzaro in Italy investigated the relationship between bone mineral density and duodenal mucosa healing in celiac patients on a gluten-free diet. (Low bone density is a risk factor for people with celiac disease, even those who are gluten-free.)
Researchers found that older patients, diagnosed at a later age and with a shorter gluten-free period, were at higher risk of bone impairment. Young celiac patients who started the gluten-free diet early in life could achieve normalization of bone density. The duration of the gluten-free diet to normalize bone mineral density remains unclear.
The novel finding of this study was that a DEXA bone scan may have a place in the follow-up of celiac disease patients, particularly to help select patients who need a control biopsy to assess intestinal healing and those who don’t.
Researchers found the association between normal bone mineral density and duodenal mucosa healing was so strong that normal DEXA results could be used as evidence of intestinal healing.
“DEXA may be a useful tool in the management of adult celiac patients and the timely planning of endoscopic biopsy resampling,” researchers wrote. The study was published in Nutrients.
In a separate study, researchers found that vitamin and mineral deficiencies related to decreased bone density could be severe but unrelated to the presence of gastrointestinal symptoms. Evaluation of bone biomarkers and a DEXA bone examination should be considered in celiac patients over 30, they concluded. The study was published in the European Journal of Gastroenterology & Hepatology.
Peanut-Free Tables in Schools
Peanut allergy, the third leading food allergy in U.S. children, is a frequent cause of fatal reactions and the most common trigger of anaphylaxis in schools. And rates of peanut allergy are rising.
A team of researchers set out to determine the effectiveness of peanut-free policies in preventing allergic reactions in schools. They analyzed rates of epinephrine administration in all Massachusetts public schools and looked at school nurse survey reports of peanut-free policies from 2006 to 2011. Rates of epinephrine administration were compared for schools with and without peanut-restrictive policies.
The researchers found that none of the peanut-free policies was associated with complete absence of allergic reactions. Policies restricting peanuts from home, peanuts served in schools or the presence of peanut-free classrooms did not affect epinephrine administration rates. But the schools with peanut-free tables in their cafeterias had lower rates of epinephrine administration than the schools without such tables.
More studies are needed before decisions can be made regarding peanut-free policies in schools, researchers said. The study was published in the Journal of Clinical Immunology.
Timing of Food Introduction
A team of researchers in Canada examined the relationship between timing and patterns of food introduction and sensitization to certain foods (i.e., cow’s milk products, eggs and peanuts) in 2,124 children during their first year of life. Infants with eczema or hives by age 6 months were excluded from this study.
Results showed that avoiding these foods in the first year of life and introducing them later significantly increased the odds of the children becoming sensitive to them. The research was published in Pediatric Allergy and Immunology.
Editor’s note: Always consult with your pediatrician about introducing foods to your infant.