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Frontiers in Medicine 2023The term gluten-related disorders (GRD) refer to a spectrum of different clinical manifestations triggered by the ingestion of gluten in genetically susceptible... (Review)
Review
The term gluten-related disorders (GRD) refer to a spectrum of different clinical manifestations triggered by the ingestion of gluten in genetically susceptible individuals, including coeliac disease (CD), wheat allergy and non-celiac gluten sensitivity (NCGS). GRD are characterized by a large variety of clinical presentations with both intestinal and extra-intestinal manifestations. The latter may affect almost every organ of the body, including the skin. Besides the well-known association between CD and dermatitis herpetiformis, considered as the cutaneous specific manifestation of CD, many other muco-cutaneous disorders have been associated to GRD. In this review, we analyzed the main features of dermatological diseases with a proven association with GRD and those that improve after a gluten-free diet, focusing on the newly described cutaneous manifestations associated with NCGS. Our main hypothesis is that a "cutaneous-gluten sensitivity," as specific cutaneous manifestation of NCGS, may exist and could represent a diagnostic marker of NCGS.
PubMed: 37265490
DOI: 10.3389/fmed.2023.1155288 -
Frontiers in Immunology 2020
Topics: Animals; Autoimmune Diseases; Autoimmunity; Disease Management; Disease Susceptibility; Humans; Pemphigoid, Bullous; Pemphigus
PubMed: 32793239
DOI: 10.3389/fimmu.2020.01614 -
World Journal of Gastroenterology Apr 2018Non celiac gluten sensitivity (NCGS) is a syndrome characterized by a cohort of symptoms related to the ingestion of gluten-containing food in subjects who are not... (Review)
Review
Non celiac gluten sensitivity (NCGS) is a syndrome characterized by a cohort of symptoms related to the ingestion of gluten-containing food in subjects who are not affected by celiac disease (CD) or wheat allergy. The possibility of systemic manifestations in this condition has been suggested by some reports. In most cases they are characterized by vague symptoms such as 'foggy mind', headache, fatigue, joint and muscle pain, leg or arm numbness even if more specific complaints have been described. NCGS has an immune-related background. Indeed there is a strong evidence that a selective activation of innate immunity may be the trigger for NCGS inflammatory response. The most commonly autoimmune disorders associated to NCGS are Hashimoto thyroiditis, dermatitis herpetiformis, psoriasis and rheumatologic diseases. The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported; it could be a characteristic feature that could help the diagnosis and be simultaneously managed. A possible neurological involvement has been underlined by NCGS association with gluten ataxia, gluten neuropathy and gluten encephalopathy. NCGS patients may show even psychiatric diseases such as depression, anxiety and psychosis. Finally, a link with functional disorders (irritable bowel syndrome and fibromyalgia) is a topic under discussion. In conclusion, the novelty of this matter has generated an expansion of literature data with the unavoidable consequence that some reports are often based on low levels of evidence. Therefore, only studies performed on large samples with the inclusion of control groups will be able to clearly establish whether the large information from the literature regarding extra-intestinal NCGS manifestations could be supported by evidence-based agreements.
Topics: Autoimmune Diseases; Food Hypersensitivity; Glutens; Humans; Immunity, Innate; Intestines; Irritable Bowel Syndrome; Mental Disorders; Nervous System Diseases; Nutrition Disorders; Skin Diseases
PubMed: 29662290
DOI: 10.3748/wjg.v24.i14.1521 -
Clinical and Experimental Dermatology Oct 2019Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease (CD), which causes an itching and blistering rash, typically on the elbows, knees and... (Review)
Review
Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease (CD), which causes an itching and blistering rash, typically on the elbows, knees and buttocks. DH and CD share a similar genetic background, small bowel mucosal alterations, and an autoimmune response against tissue transglutaminase in the serum and small bowel. DH is typically diagnosed during adulthood, and it is slightly more common among males than females. The incidence of DH seems to be decreasing, in contrast to the detected four-fold increase in the incidence of CD. In addition to typical clinical picture, diagnosis of DH relies on the demonstration by direct immunofluorescence of pathognomonic granular IgA deposits in the papillary dermis. Circulating tissue transglutaminase antibodies support the diagnosis, but their absence does not exclude DH. Obtainment of small bowel mucosal biopsies is not necessary when DH is diagnosed, but if performed, the majority of patients are found to have villous atrophy, and even those with normal villous architecture evince CD-type inflammation. The treatment of choice in DH is a strict, life-long adherence to a gluten-free diet (GFD). In addition to alleviating the symptoms of DH and healing the small bowel mucosal damage, a GFD increases the quality of life for patients, and decreases the risk for lymphoma in DH. Further, the mortality rate of patients with DH treated with a GFD seems to be lower than that of the general population. However, as changing to a GFD has a rather slow effect on the DH rash, patients with severe skin symptoms should additionally be treated with dapsone medication. This review article is based on a presentation given at the British Society for Medical Dermatology blistering skin diseases meeting 2019.
Topics: Celiac Disease; Dermatitis Herpetiformis; Diet, Gluten-Free; Humans; Prognosis
PubMed: 31093998
DOI: 10.1111/ced.13992 -
Digestive and Liver Disease : Official... Oct 2022Coeliac disease and dermatitis herpetiformis are immune-mediated diseases triggered by the consumption of gluten in genetically predisposed individuals. These guidelines...
INTRODUCTION
Coeliac disease and dermatitis herpetiformis are immune-mediated diseases triggered by the consumption of gluten in genetically predisposed individuals. These guidelines were developed to provide general practitioners, paediatricians, gastroenterologists, and other clinicians with an overview on the diagnosis, management and follow-up of coeliac patients and those with dermatitis herpetiformis.
METHODS
Guidelines were developed by the Italian Societies of Gastroenterology. Following a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the certainty of the evidence. Statements and recommendations were developed by working groups consisting of gastroenterologists and a paediatrician with expertise in this field.
RESULTS
These guidelines provide a practical guidance for the diagnosis, management and follow-up of coeliac patients and dermatitis herpetiformis in children and adults, both in primary care and in specialist settings. We developed four sections on diagnosis, gluten-free diet, follow-up and risk of complications in adults, one section focused on diagnosis and follow-up in children and one on the diagnosis and management of dermatitis herpetiformis.
CONCLUSIONS
These guidelines may support clinicians to improve the diagnosis and management of patients with coeliac disease.
Topics: Adult; Celiac Disease; Child; Dermatitis Herpetiformis; Diet, Gluten-Free; Gastroenterology; Glutens; Humans; Systematic Reviews as Topic
PubMed: 35858884
DOI: 10.1016/j.dld.2022.06.023 -
Clinical Medicine (London, England) May 2021Immunobullous diseases are blistering cutaneous disorders that are caused by pathogenic antibodies binding to protein targets within the skin. There are a range of...
Immunobullous diseases are blistering cutaneous disorders that are caused by pathogenic antibodies binding to protein targets within the skin. There are a range of immunobullous disorders with characteristic morphology that relates to the structural properties of the target protein. In this article we will describe the pathogenesis, clinical features and treatment of the most common immunobullous disorders.
Topics: Epidermolysis Bullosa Acquisita; Humans; Pemphigoid, Bullous; Skin; Skin Diseases, Vesiculobullous
PubMed: 34001564
DOI: 10.7861/clinmed.2021-0232 -
European Journal of Dermatology : EJD Apr 2019Dermatitis herpetiformis (DH) is a pruritic papulovesicular disease that is relatively common in Caucasian populations, and was first reported by Louis Duhring. It is... (Review)
Review
Dermatitis herpetiformis (DH) is a pruritic papulovesicular disease that is relatively common in Caucasian populations, and was first reported by Louis Duhring. It is characterized by granular IgA deposition in the dermal-epidermal junction and gluten-sensitive enteropathy (GSE) associated with human leukocyte antigen-DQ2/DQ8 haplotype. In contrast, DH is rare in Japan, and Japanese DH patients occasionally show unique features, including a high frequency of fibrillar IgA deposition in the papillary dermis, and rare occurrence of GSE. We refer to this condition in Japanese patients as "fibrillar-type DH", while the DH that is typically observed in the Caucasian population is referred to as "granular-type DH". In patients with typical fibrillar-type DH, IgA antibodies to epidermal transglutaminase are the only antibodies detected. In addition, Th2-type cytokines, such as interleukin (IL)-4, IL-5 and IL-13, may be important in the development of skin lesions in fibrillar-type DH (especially in the infiltration of tissue by eosinophils), as in granular-type DH. The pathogenesis of fibrillar-type DH may differ from that of granular-type DH, which is dependent on gluten and in which IgA antibodies to tissue transglutaminase (the main antigen in GSE) are detected. We herein review the clinical, histological, and immunological findings of fibrillar-type DH.
Topics: Asian People; Celiac Disease; Cytokines; Dermatitis Herpetiformis; Humans; Immunoglobulin A; Japan
PubMed: 31106757
DOI: 10.1684/ejd.2019.3533