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These 2 recent articles are of great interest:
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Lancet. 2003 Jun 21;361(9375):2152-2154.
Is Candida albicans a trigger in the onset of coeliac disease?
Nieuwenhuizen WF, Pieters R, Knippels L, Jansen M, Koppelman SJ.
Netherlands Organisation for Applied Scientific Research (TNO) Nutrition
and Food Research, PO Box 360, 3700 AJ, Zeist, Netherlands
Coeliac disease is a T-cell-mediated autoimmune disease of the small
intestine that is induced by ingestion of gluten proteins from wheat,
barley, or rye. We postulate that Candida albicans is a trigger in the
onset of coeliac disease. The virulence factor of C albicans-hyphal wall
protein 1 (HWP1)-contains aminoacid sequences that are identical or highly
homologous to known coeliac disease-related alpha-gliadin and gamma-gliadin
T-cell epitopes. HWP1 is a transglutaminase substrate, and is used by C
albicans to adhere to the intestinal epithelium. Furthermore, tissue
transglutaminase and endomysium components could become covalently linked
to the yeast. Subsequently, C albicans might function as an adjuvant that
stimulates antibody formation against HWP1 and gluten, and formation of
autoreactive antibodies against tissue transglutaminase and endomysium.
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J Pediatr Gastroenterol Nutr. 2003 Jul;37(1):63-66.
Autoimmune Thyroid Disease and Celiac Disease in Children.
Ansaldi N, Palmas T, Corrias A, Barbato M, D'Altiglia MR, Campanozzi A,
Baldassarre M, Rea F, Pluvio R, Bonamico M, Lazzari R, Corrao G.
Azienda Ospedaliera O.I.R.M.-S.ANNA, III Divisione Universitaria di
Pediatria, Servizio di Gastroenterologia, Universita di Torino; Istituto di
clinica Pediatrica "La Sapienza" Roma, III Cattedra di Pediatria, Servizio
Speciale di Gastroenterologia Pediatrica; Osp. "Casa Sollievo della
Sofferenza," S. Giovanni Rotondo, Divisione di Pediatria; Dipartimento di
Bio Medicina dell'Eta Evolutiva, Universita di Bari; Clinica Pediatrica
III, Seconda Universita di Napoli; Azienda Policlinico Umberto I,
Universita "La Sapienza" Roma; Clinica Pediatrica III, Bologna; Universita
degli studi di Milano-Bicocca, Italy.
BACKGROUND: Celiac disease (CD) may be associated with other immunologic
disorders in adults and children. Previous studies linking CD and
autoimmune thyroid disease in children have included very few patients with
limited biochemical and immunologic screening tests. The aim of this
multicenter study was to establish the prevalence of autoimmune thyroid
involvement in a large series of pediatric patients with CD.
METHODS: Five hundred seventy-three consecutive pediatric patients were
enrolled from clinics in Torino, Bologna, Foggia, Rome (two clinics),
Naples, and Bari. Three hundred forty-three patients with CD were studied,
230 girls and 113 boys (median age, 8.5 years). Two hundred fifty-six of
the patients with CD (median age, 9 years) had been following a gluten-free
diet for 3 months to 16 years; 87 patients were untreated (median age, 6.2
years). The diagnosis of CD was made using the European Society for
Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria. A
control group of 230 subjects (median age, 8.3 years) was enrolled. Serum
free triiodothyronine, free thyroxine, and thyroid-stimulating hormone
(TSH), antithyroperoxidase, antithyroglobulin, anti-TSH receptor
antibodies, and thyroid echographic pattern were considered.
RESULTS: Autoimmune thyroid disease was found in 90 of 343 (26.2%) patients
with CD (62 on a gluten-free diet) and in 20 (10%) of the control subjects
(P = 0.001). Fifty-four (15.7%) patients with CD and autoimmune markers had
normal thyroid function (euthyroidism) as did 12 (6.0%) of the control
subjects; hypothyroidism was observed in 28 (8.1%) patients with CD and in
7 (3.5%) of the control subjects. Hyperthyroidism was diagnosed in four
patients with CD and in none of the control subjects with autoimmune
markers. An abnormal echographic pattern was seen in 37 patients with CD
(16.8%) and only in 1 (1.6%) of the control subjects (P = 0.002).
CONCLUSIONS: The high frequency of autoimmune thyroid disease found among
patients with CD, even those on a gluten-free diet, may justify a thyroid
status assessment at diagnosis and at follow-up evaluation of children with
CD.
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