Patient Care - Allergy & Immunology - October 2007 - (Page 11)

Celiac disease I D and B12. Vitamin D supplementation is particularly important in patients with osteopenia or osteoporosis. Patients with celiac disease should receive pneumococcal vaccine (Pneumovax) because they very commonly have poor splenic function. As a result, they are at increased risk of pneumococcal pneumonia and meningitis. Patients may also benefit from the resources of local or national celiac disease support groups in adhering to a gluten-free diet and also in coping with the associated lifestyle changes. Seventy percent of patients report symptom improvement within 2 weeks of initiating the gluten-free diet. Poor response may be due to continued ingestion of gluten, lactose or fructose intolerance, incorrect diagnosis, pancreatic insufficiency, bacterial overgrowth, microscopic colitis, refractory celiac disease, or intestinal lymphoma. The initiation of pancreatic enzyme supplements and antibiotics should be considered in suspected pancreatic REFERENCES 1. Not T, Horvath K, Hill ID, et al. Celiac disease risk in the USA: high prevalence of antiendomysium antibodies in healthy blood donors. Scand J Gastroenterol. 1998;33:494-498. 2. Foschi F, Diani F, Zardini E, et al. Celiac disease and spontaneous abortion [in Italian]. Minerva Ginecol. 2002;54(2):151-159. 3. Pludowski P, Karczmarewicz E, Socha J, et al. Skeletal and muscular status in juveniles with GFD treated clinical and newly diagnosed atypical celiac disease—preliminary data. J Clin Densitom. 2007;10(1):76-85. 4. Alaedini A, Green PH, Sander HW, et al. Ganglioside reactive antibodies in the neuropathy associated with celiac disease. J Neuroimmunol. 2002;127:145-148. 5. Prokopova L. Celiac disease—a severe disease [in Czech]. Vnitr Lek. 2003;49(6):474-481. 6. Rodrigo L. Celiac disease. World J Gastroenterol. 2006;12:6585-6593. 7. Al Toma A, Verbeek WH, Mulder CJ. Update on the management of refractory coeliac disease. J Gastrointestin Liver Dis. 2007;16:57-63. 8. Freeman HJ. Lymphoproliferative and intestinal malignancies in 214 patients with biopsy-defined celiac disease. J Clin Gastroenterol. 2004;38:429-434. 9. Askling J, Linet M, Gridley G, et al. Cancer incidence in a populationbased cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis. Gastroenterology. 2002;123:1428-1435. 10. Smedby KE, Akerman M, Hildebrand H, et al. Malignant lymphomas in coeliac disease: evidence of increased risks for lymphoma types other than enteropathy-type T cell lymphoma. Gut. 2005;54:54-59. 11. Catassi C, Fabiani E, Corrao G, et al. Risk of non-Hodgkin lymphoma in celiac disease. JAMA. 2002;287:1413-1419. 12. Dickey W, McMillan SA, Hughes DF. Identification of coeliac disease in primary care. Scand J Gastroenterol. 1998;33:491-493. 13. Adrych KJ, Marek IE, Kryszewski AJ. Adults [with] celiac disease—the tip of the iceberg [in Polish]. Wiad Lek. 2006;59:359-363. insufficiency or bacterial overgrowth. Lactose and fructose should be avoided if intolerance is suspected. Colonoscopy with biopsy should be considered in poor responders to evaluate them for lymphocytic or collagenous colitis. 21 A diagnosis of refractory celiac disease is made when intraepithelial lymphocytes obtained from a small bowel biopsy demonstrate a CD3+, CD8immunohistologic phenotype and TCR gamma gene rearrangement. Although refractory celiac disease is not well understood, some success has occurred with corticosteroids, azathioprine, cladribine, and cyclosporine.22-24 Ulcerative jejunitis and lymphoma should be tested for if no improvement is seen with corticosteroid therapy. I This article was contributed and updated by Drs Gavin Chico and Michelle Chico. The authors disclose that they have no financial relationship with any manufacturer in this area of medicine. 14. NIH Consensus Development Conference on Celiac Disease. NIH Consens State Sci Statements. 2004;21:1-23. 15. Ludvigsson JF, Elfstrom P, Broome U, et al. Celiac disease and risk of liver disease: a general population-based study. Clin Gastroenterol Hepatol. 2007;5:63-69. 16. Kaukinen K, Halme L, Collin P, et al. Celiac disease in patients with severe liver disease: gluten-free diet may reverse hepatic failure. Gastroenterology. 2002;122:881-888. 17. Abrams JA, Diamond B, Rotterdam H, et al. Seronegative celiac disease: increased prevalence with lesser degrees of villous atrophy. Dig Dis Sci. 2004;49:546-550. 18. Villalta D, Alessio MG, Tampoia M, et al. Testing for IgG class antibodies in celiac disease patients with selective IgA deficiency: a comparison of the diagnostic accuracy of 9 IgG anti-tissue transglutaminase, 1 IgG antigliadin and 1 IgG anti-deaminated gliadin peptide antibody assays. Clin Chim Acta. 2007;382:95-99. 19. Kaukinen K, Partanen J, Maki M, et al. HLA-DQ typing in the diagnosis of celiac disease. Am J Gastroenterol. 2002;97:695-699. 20. Kapitany A, Toth L, Tumpek J, et al. Diagnostic significance of HLA-DQ typing in patients with previous coeliac disease diagnosis based on histology alone. Aliment Pharmacol Ther. 2006;24:1395-1402. 21. Fine KD, Lee EL, Meyer RL. Colonic histopathology in untreated celiac sprue or refractory sprue: is it lymphocytic colitis or colonic lymphocytosis? Hum Pathol. 1998;29:1433-1440. 22. Al-Toma A, Verbeek WH, Mulder CJ. Update on the management of refractory coeliac disease. J Gastrointestin Liver Dis. 2007;16:57-63. 23. Brar P, Lee S, Lewis S, et al. Budesonide in the treatment of refractory celiac disease. Am J Gastroenterol. 2007;June 20 [Epub ahead of print]. 24. Al-Toma A, Goerres MS, Meijer JW, et al. Cladribine therapy in refractory celiac disease with aberrant T cells. Clin Gastroenterol Hepatol. 2006; 4:1322-1327. OCTOBER 2007 PATIENT CARE ALLERGY & IMMUNOLOGY 11

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Patient Care - Allergy & Immunology - October 2007 Research Digest Contents Medicine in the News When to Suspect Celiac Disease and How to Proceed From There Averting Angioedema’s Potentially Dire Consequences Is There a Role for Leukotriene Receptor Antagonists in Treating Allergic rhinitis? Clinical Clips Dermatology Case Challenge Classified Advertising

Patient Care - Allergy & Immunology - October 2007

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