Research Roundup: August/September 2018
The latest medical news for people with allergies and food sensitivities.
Celiac Disease in Seniors
It’s not uncommon for celiac disease to develop in older patients and it’s important to make the diagnosis, says a group of researchers in Finland and the U.K. In a new study published in Alimentary Pharmacology and Therapeutics, these researchers report that celiac disease is now being diagnosed more frequently in seniors. About a quarter of all celiac diagnoses are now made at the age of 60 and over. A fifth are made at 65 and older. And about 4 percent of new celiacs are diagnosed at age 80 and above.
Like all diagnosed with celiac disease, older patients must change life-long eating patterns, a challenge for many seniors. In addition, elderly patients on fixed incomes may find the higher price point of most gluten-free packaged foods harder to manage. Even so, over 90 percent of celiac seniors show good compliance with the gluten-free diet, as well as resolution of their symptoms and improvement on blood tests. Recovery of intestinal damage is also good, although it occurs at a slower pace than in younger patients.
Still, about 60 percent of elderly celiac patients remain undiagnosed; their symptoms may be subtle and dismissed as part of aging. “Old age itself should never be blamed for clinical features such as tiredness, indigestion, reduced appetite or anemia which may be due to celiac disease,” the researchers wrote.
Since life expectancy is expected to increase, it’s likely that the rate of celiac disease in the elderly will also rise. The researchers urge healthcare providers to be alert to celiac disease in older patients.
Acid Suppressors, Antibiotics Linked to Childhood Allergies
Infants who received acid suppressive medications or antibiotics during their first six months of life were more likely to develop allergic disease in childhood, according to a large study of over 790,000 children conducted by researchers at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and the Dwight D. Eisenhower Army Medical Center in Ft. Gordon, Georgia.
“Use of acid-suppressive medications was positively associated with increased risks for all major categories of allergic disease and most strongly associated with food allergy,” the researchers reported.
Babies who received H2RAs (histamine-2 receptor antagonist) or PPIs (proton pump inhibitors) during their first 6 months were more than twice as likely to develop food allergies and had slightly less than 2-fold risk for medication allergies as the babies who did not. They were also more likely to experience anaphylaxis, allergic rhinitis and asthma. Antibiotic exposure during the first six months of life was also significantly associated with the major categories of allergic diseases.
“This study adds to the mounting evidence that agents that disrupt the normal intestinal microbiome during infancy may increase the development of allergic diseases,” the researchers wrote. “[It] provides further impetus that antibiotics and acid-suppressive medications should be used during infancy only in situations of clear clinical benefit.”
Additional studies are needed to determine the precise mechanism and confirm causality. The study was published online in JAMA Pediatrics.
Experimental Drug May Solve Gluten Cross-Contact
American biopharmaceutical company Amgen announced a first proof-of-concept study showing that AMG 714 (anti-IL-15 monoclonal antibody) may protect celiac patients from inadvertent gluten exposure.
AMG 714 is an investigational new drug, an antibody that blocks interleukin 15, an important mediator of celiac disease. Proposed as a monthly shot, it may lead to fewer symptoms for celiacs who unintentionally ingest gluten.
“It’s important to note that this drug is being investigated for its potential to protect against modest contamination, not deliberately eating large amounts of gluten, like bread or pasta,” said Francisco Leon, MD, PhD, the study director and consultant for Amgen. “Our hope is that this drug may allow celiac patients on a gluten-free diet to experience fewer gluten-triggered events.”
The study was a randomized, double-blind, placebo-controlled, phase 2a study that compared two dose levels of AMG 714 to a placebo, administered to celiac patients over 10 to 12 weeks. While AMG 714 didn’t fully prevent gluten-induced mucosal injury in the gluten-challenged group, researchers saw a decrease in intestinal inflammation. Reduction in symptoms was also observed, especially in the group that took the larger dose of the drug.
The study was presented at Digestive Disease Week in June. Continued research (a phase 2b study) is planned.
Why So Much Undiagnosed Celiac Disease?
Although 1 percent of the population (approximately 3 million people in the United States) has celiac disease, a large percentage (about 83 percent) remains undiagnosed despite growing public awareness. A group of researchers at Mayo Clinic wanted to know why. They conducted a study to determine the indications for diagnostic testing and frequency of clinical testing in undiagnosed celiac disease. Their study was based on screening of over 47,000 stored blood samples taken from patients in Olmsted County, Minnesota.
In clinical practice, diagnosis of celiac disease is driven by case finding, the practice of testing people who are at increased risk for the disease due to symptoms or associated conditions. The high rate of undiagnosed celiac disease suggests that this method isn’t an effective strategy.
The study found that most of the common indicators for celiac testing don’t predict undiagnosed celiac disease. It also found that over time, people with undiagnosed celiac go on to develop “more indications for testing, specifically osteoporosis, dermatitis herpetiformis, chronic fatigue, thyroiditis and autoimmune disease.” Hypothyroidism was more likely in cases of undiagnosed celiac; dyspepsia (impaired digestion) and chronic diarrhea were less likely.
So how to detect celiac disease? Researchers discussed methods like mass screening, natural language processing software of electronic medical records, and systematic collection of symptoms and family history as some potential strategies. They concluded that case finding alone was likely ineffective and that “alternative methods of detecting symptomatic celiac disease are needed.”
The study was published in Alimentary Pharmacology and Therapeutics.
Allergies & Asthma Linked to Mental Health
Researchers in Taiwan looked at the association between allergic diseases, such as asthma, allergic rhinitis and atopic dermatitis, and the risk of psychiatric disorders in Taiwan’s population. Their study found that adult patients with allergic diseases were at “significantly higher risk of psychiatric disorders than the control group.”
While the underlying mechanism between allergic diseases and mental health remains unclear, researchers noted the possible role of pro-inflammatory cytokines.
“Further studies are therefore needed for patients with allergic diseases not only to prevent its clinical exacerbation but also to decrease the possibility of developing psychiatric disorders,” the researchers concluded.
The study was published in Frontiers in Psychiatry.