Clinical, Serologic, and Histologic Features of Gluten Sensitivity in Children

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• 作者：Ruggiero Francavilla ; MD ; PhD¹ ; ^{rfrancavilla@gmail.com" class="auth_mail} ; Fernanda Cristofori ; MD¹ ; Stefania Castellaneta ; MD² ; Carlo Polloni ; MD³ ; Veronica Albano ; MD⁴ ; Stefania Dellatte⁵ ; Flavia Indrio ; MD¹ ; Luciano Cavallo ; MD¹ ; Carlo Catassi ; MD ; PhD⁴
• 关键词：AGA ; Antigliadin antibodies ; APT ; Atopy patch test ; CD ; Celiac disease ; EMA ; Endomysial antibody ; GFD ; Gluten-free diet ; GS ; Gluten sensitivity ; IEL ; Intraepithelial lymphocyte ; SPT ; Skin prick test ; tTG ; Tissue transglutaminase ; WA ; Wheat allergy
• 刊名：The Journal of Pediatrics
• 出版年：March, 2014
• 年：2014
• 卷：164
• 期：3
• 页码：463-467.e1
• 全文大小：148 K

文摘

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Objective

To describe the clinical, serologic, and histologic characteristics of children with gluten sensitivity (GS).

Study design

We studied 15 children (10 males and 5 females; mean age, 9.6 卤 3.9 years) with GS who were diagnosed based on a clear-cut relationship between wheat consumption and development of symptoms, after excluding celiac disease (CD) and wheat allergy, along with 15 children with active CD (5 males and 10 females; mean age, 9.1 卤 3.1 years) and 15 controls with a functional gastrointestinal disorder (6 males and 9 females; mean age, 8.6 卤 2.7 years). All children underwent CD panel testing (native antigliadin antibodies IgG and IgA, anti-tissue transglutaminase antibody IgA and IgG, and anti-endomysial antibody IgA), hematologic assessment (hemoglobin, iron, ferritin, aspartate aminotransferase, erythrocyte sedimentation rate), HLA typing, and small intestinal biopsy (on a voluntary basis in the children with GS).

Results

Abdominal pain was the most prevalent symptom in the children with GS (80%), followed by chronic diarrhea in (73%), tiredness (33%), bloating (26%), limb pain, vomiting, constipation, headache (20%), and failure to thrive (13%). Native antigliadin antibodies IgG was positive in 66% of the children with GS. No differences in nutritional, biochemical, or inflammatory markers were found between the children with GS and controls. HLA-DQ2 was found in 7 children with GS. Histology revealed normal to mildly inflamed mucosa (Marsh stage 0-1) in the children with GS.

Conclusion

Our findings support the existence of GS in children across all ages with clinical, serologic, genetic, and histologic features similar to those of adults.