Manifestazioni extraintestinali di celiachia

La celiachia è una malattia autoimmune che si manifesta in individui geneticamente predisposti, risultante da risposta immunitaria al glutine. È presente in circa l’1% della popolazione.

La diarrea è presente in <50% dei casi. Altre presentazioni includono: anemia sideropenica, osteoporosi, dermatite erpetiforme, disturbi neurologici, neuropatia periferica prevalentemente e atassia.
L’artrite si trova comunemente nei pazienti con malattia celiaca, quando sistematicamente ricercata.
Nel complesso, malattie autoimmuni si verificano più frequentemente (da tre a dieci volte di più) in soggetti con malattia celiaca rispetto alla popolazione generale.
Una dieta priva di glutine è trattamento standard, anche se l’effetto su alcune manifestazioni extraintestinali rimane da stabilire.

Curr Gastroenterol Rep. 2006 Oct;8(5):383-9.
Extraintestinal manifestations of celiac disease.
Hernandez L, Green PH.

Celiac disease is an autoimmune disorder that occurs in genetically predisposed individuals as the result of an immune response to gluten. It is present in approximately 1% of the population.
Diarrhea has become a less common mode of presentation (<50% of cases) than it once was.
Other presentations include iron-deficiency anemia, osteoporosis, dermatitis herpetiforme, and neurologic disorders, mainly peripheral neuropathy and ataxia. Arthritis is commonly found in patients with celiac disease when systematically sought.
Overall, autoimmune diseases occur more frequently (three to ten times more) in those with celiac disease than in the general population.
A gluten-free diet is the standard of treatment, although its effect on some of the extraintestinal manifestations remains to be determined.

Intolleranza al glutine e malattie della pelle

La sensibilità al glutine, con o senza malattia celiaca (CD) sintomi e patologie intestinali, è stato proposta come causa, potenzialmente trattabile, di diverse malattie e condizioni della pelle.
Diversi dati dimostrano che la dermatite erpetiforme è in realtà una manifestazione cutanea di CD. Sono stati descritti anche
malattie autoimmuni e allergiche e psoriasi con intolleranza al glutine. Questa dà luogo a manifestazioni dermatologiche che possono beneficiare di una dieta priva di glutine.
Opportuno lo screening sierologico per
anticorpi antigliadina,
antiendomisio e
anti-transglutaminasi.
La tipizzazione HLA
è spesso utile in associazione con i test sierologici, come pure in alcuni casi la biopsia intestinale.

Eur J Dermatol. 2006 Jan-Feb;16(1):4-11.
Gluten intolerance and skin diseases.
Humbert P, Pelletier F, Dreno B, Puzenat E, Aubin F.

Gluten sensitivity with or without coeliac disease (CD) symptoms and intestinal pathology has been suggested as a potentially treatable cause of various diseases. CD is a chronic disease which improves on withdrawal of wheat gliadins and barley, rye and oat prolamins from the diet. There have been numerous reports linking CD with several skin conditions. A body of evidence shows that dermatitis herpetiformis is actually a cutaneous manifestation of CD. Autoimmune diseases, allergic diseases, psoriasis and miscellaneous diseases have also been described with gluten intolerance. Dermatologists should be familiar with the appraisal of gluten sensitive enteropathy and should be able to search for an underlying gluten intolerance (GI). Serological screening by means of antigliadin, antiendomysial and transglutaminase antibodies should be performed. HLA typing is often useful in association with serologic tests. Intestinal biopsy is usually needed to establish the diagnosis of CD or GI. Thus, gluten intolerance gives rise to a variety of dermatological manifestations which may benefit from a gluten-free diet.

Indice di massa corporea e malattie della pelle in celiaci

Indice di massa corporea e la prevalenza delle malattie della pelle negli adulti con malattia celiaca non trattata.

La celiachia (CD) è associata a malattie immuno-mediate della pelle come la dermatite erpetiforme e altre.
Lo studio ha esaminata la relazione tra indice di massa corporea (BMI), come un indice dello stato di assorbimento, e prevalenza di malattie della pelle in adulti con celiachia non trattata.
Viene concluso che il BMI è positivamente correlato alla prevalenza di psoriasi e dermatite erpetiforme, non a quella di altre malattie immuno-mediate della pelle.

 

Digestion. 2009;80(1):18-24. Epub 2009 May 7.
Body mass index and prevalence of skin diseases in adults with untreated coeliac disease.
Zingone F, Bucci C, Tortora R, Santonicola A, Cappello C, Franzese MD, Passananti V, Ciacci C.

OBJECTIVE: Coeliac disease (CD) is associated with immune-mediated skin diseases such as dermatitis herpetiformis and others.
The objective of the study was to investigate the relation of body mass index (BMI), as an index of absorptive status, with the prevalence of skin diseases in adults with untreated CD.

METHODS: Anthropometry, gastro-intestinal symptoms, nutritional indices and immune-mediated skin diseases (dermatitis herpetiformis, psoriasis, aphthosis and alopecia) at diagnosis were analysed.
RESULTS: 223 men and 924 women with untreated CD (aged 20-60 years) were included, the commonest skin disease was dermatitis herpetiformis (18.4 and 6.9%, respectively), the rarest one was alopecia (1.8 and 2.1%). The BMI was positively associated with male gender, age at diagnosis and nutritional indices, negatively with diarrhoea and dyspepsia (p < 0.001). A BMI difference of 3.5 (1 standard deviation) was related to an excess prevalence of dermatitis herpetiformis (odds ratio, OR = 1.46, 95% confidence interval, CI = 1.23-1.72) and of psoriasis (OR = 1.40, 95% CI = 1.10-1.79) but not of other immunological disorders. Findings were similar in analyses by gender or age group and controlled for gender and age. The relation of BMI to dermatitis herpetiformis was linear over the whole BMI range, also excluding overweight patients. The relation of BMI to psoriasis was flat for low-to-normal BMI and explained only by overweight patients.
CONCLUSION: In CD at diagnosis, the BMI is positively related to the prevalence of dermatitis herpetiformis and psoriasis, not to that of other immune-mediated skin diseases.