<<Disclaimer: Verify this information before applying it to your situation.>>

In response to a post on this listserv stating that both a pediatrician 
and a dermatologist dismissed the possibility of a connection between 
previously diagnosed celiac disease and geographic tongue, I  offer the 
following:


One of several early mentions of geographic tongue (glossitis) in 
association with celiac disease may be found in the medical textbook 
"Coeliac Disease" by Cooke and Holmes, Churchill Livingstone, 1984, on 
pages 84 and 85 under the heading "glossitis". They say that it occurs, 
to a greater or lesser extent, "in a majority of celiac patients".

an image of severe glossitis can be seen at
http://www.nejm.org/doi/full/10.1056/NEJMicm0810145

Another very informative article on glossitis can be found at
http://www.nejm.org/doi/full/10.1056/NEJMc070200

In this recent article from the New England Journal of Medicine (2007)  
the authors also state that the connection between celiac disease and 
glossitis is very common. They go on to say: "Our report should alert 
physicians and dental practitioners to consider celiac disease in 
managing cases of idiopathic atrophic glossitis." In other words, they 
want physicians and dentists to be aware that there may be underlying 
celiac disease when they encounter glossitis. This information is 
neither controversial nor difficult to locate. Celiac disease is not the 
only cause of glossitis, or geographic tongue, but it is a common and 
long acknowledged symptom of celiac disease, with mention of this 
connection in the medical literature at least as early as 1974 (3, 4).

My own experience with glossitis is that most of my problems went away 
when I began a GF diet. The remainder of my glossitis resolved after 
getting IgG food allergy testing from Immuno Labs in Ft. Lauderdale, and 
removing all identified allergenic foods from my diet. (I have since 
re-introduced some of these foods but I avoided them for about 5 years. 
( 12 years later, I still have to avoid some of the foods identified by 
that testing.)

My questions/concerns are:
1. Is your daughter eating gluten? Is it possible that there is gluten 
contamination in her diet?
2. Is she eating oats? A significant portion of celiac patients do react 
to oats, yet oat consumption is now widely advocated.
3. Has she had testing for common food allergies? If she is strictly GF 
and avoiding oats, then food allergy testing may provide her with the 
the information she needs to eliminate this source of her discomfort.

I am distressed that neither the pediatrician nor the dermatologist took 
just a few minutes to run a Medline search that would have informed them 
about the connection between celiac disease and glossitis and some 
possible treatments for her problem.  Accidental or intentional gluten 
consumption, oats consumption, and food allergy testing are all 
relatively easy for either of these physicians to address. There may, of 
course, be some other explanation for your daughter's affliction, but 
these physicians' ignorance of the connection with celiac disease and 
their failure to run a quick Medline search does not inspire confidence 
in their opinions.  You might want to pursue a third opinion on this 
issue, especially since the topical drug she was prescribed falls well 
short of solving such autoimmune/allergic problems, which almost 
assuredly is the underlying cause of your daughter's difficulties with 
her tongue.

Sources:

1. Masferrer E, & Jucgla A. Geographic Tongue. N Engl J Med 2009; 
361:e44November 12, 2009.
2. Pastore L &  Lo Muzio L. Atrophic Glossitis Leading to the Diagnosis 
of Celiac DiseaseN Engl J Med 2007; 356:2547June 14, 2007
3. Lampert F, Harms K, Bidlingmaier F, Kiefhaber P, Meister P.Pernicious 
anemia with dermatologic and neurologic involvement in a 10-year-old 
boy. Monatsschr Kinderheilkd. 1974 May;122(5):217-20.
4. Barry RE, Baker P, Read AE.Coeliac disease. The clinical 
presentation. Clin Gastroenterol. 1974 Jan;3(1):55-69

I hope this helps.
Best Wishes,
Ron


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