Early Vaccinations Are Not Risk Factors for Celiac Disease

Myléus, Anna; Stenlund, Hans; Hernell, Olle; Gothefors, Leif; Hammarström, Marie‐Louise; Persson, Lars‐Åke; Ivarsson, Anneli

doi:10.1542/peds.2011-2806

Cited by 19 publications

(12 citation statements)

References 38 publications

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“…Similarly to antibiotics and early infections, early vaccinations also influence the immune system. We have previously shown that BCG vaccination is associated with a protective effect for celiac disease, although this has to be interpreted with caution [40]. Adjusting the association between early infections and celiac disease for BCG vaccination status did not affect the association (data not shown).…”

Section: Discussionmentioning

confidence: 86%

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Early infections are associated with increased risk for celiac disease: an incident case-referent study

et al. 2012

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BackgroundCeliac disease is defined as a ‘chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals’. Sweden has experienced an “epidemic” of celiac disease in children below two years of age. Celiac disease etiology is considered multifactorial; however, little is known regarding potential risk- or protecting factors. We present data on the possible association between early infectious episodes and celiac disease, including their possible contribution to the Swedish celiac disease epidemic.MethodsA population-based incident case-referent study (475 cases, 950 referents) with exposure information obtained via a questionnaire (including family characteristics, infant feeding, and the child’s general health) was performed. Celiac disease cases were diagnosed before two years of age, fulfilling the diagnostic criteria of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. Referents were randomly selected from the national population register after fulfilling matching criteria. The final analyses included 954 children, 373 (79%) cases and 581 (61%) referents, with complete information on main variables of interest in a matched set of one case with one or two referents.ResultsHaving three or more parental-reported infectious episodes, regardless of type of infection, during the first six months of life was associated with a significantly increased risk for later celiac disease, and this remained after adjusting for infant feeding and socioeconomic status (odds ratio [OR] 1.5; 95% confidence interval [CI], 1.1-2.0; P=0.014). The celiac disease risk increased synergistically if, in addition to having several infectious episodes, infants were introduced to dietary gluten in large amounts, compared to small or medium amounts, after breastfeeding was discontinued (OR 5.6; 95% CI, 3.1-10; P<0.001).ConclusionThis study suggests that having repeated infectious episodes early in life increases the risk for later celiac disease. In addition, we found a synergistic effect between early infections and daily amount of gluten intake, more pronounced among infants for whom breastfeeding had been discontinued prior to gluten introduction. Regarding contribution to the Swedish celiac disease epidemic, which partly was attributed to concurrent changes in infant feeding, early infections probably made a minor contribution via the synergistic effect with gluten amount.

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Section: Discussionmentioning

confidence: 86%

“…Adjusting the association between early infections and celiac disease for BCG vaccination status did not affect the association (data not shown). Other vaccinations within the Swedish national program were not risk factors [40]. …”

Section: Discussionmentioning

confidence: 99%

Early infections are associated with increased risk for celiac disease: an incident case-referent study

et al. 2012

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“…Vaccinations, due to modulation of immunity, have been proposed to be involved in the process of developing autoimmune diseases [57] . Scarce data available with regards to CD fail to support this hypothesis [58] .…”

Section: Other Environmental Factorsmentioning

confidence: 99%

Primary Prevention of Celiac Disease: Environmental Factors with a Focus on Early Nutrition

et al. 2015

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Celiac disease (CD) is a common autoimmune disorder caused by ingestion of gluten. When diagnosed, it should be treated with a lifelong, strict gluten-free diet. Early infant feeding practices have been suggested as a means of preventing CD. In the last few decades, observational data have suggested that breastfeeding, especially at the time of introducing gluten into the infant's diet, as well as the time and mode of gluten first being given to a child could prevent or delay the occurrence of CD. As a result, recommendations advised that it is prudent to avoid both early (<4 months) and late (>7 months) introduction of gluten, and to introduce gluten gradually while the infant is still being breastfed, as this may reduce the risk of celiac disease, type 1 diabetes mellitus, and wheat allergy. Recently, the results of two large randomized trials have shown that breastfeeding in general, breastfeeding during gluten introduction, and early or delayed gluten introduction do not influence the total risk of CD in genetically predisposed individuals. Introducing gluten at 4 versus 6 months in very small amounts, or at 6 versus 12 months, resulted in similar rates of CD in these children. Thus, early feeding practices seem to have no impact on the risk of developing CD during childhood. In children without the genetic predisposition, the age and mode of gluten introduction do not influence the risk anyway.

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“…However a recent study from Sweden [32] found no association between childhood immunizations and CD, and rotavirus immunizations have not yet been included in the general childhood immunization program in Sweden. Hence, biased immunization coverage in CD children is unlikely to explain our results.…”

Section: Discussionmentioning

confidence: 99%

A large nationwide population-based case–control study of the association between intussusception and later celiac disease

et al. 2013

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BackgroundCase reports and case series studies suggest a positive association between intussusception and celiac disease (CD).MethodsWe contacted Sweden’s 28 pathology departments and obtained data on 29,096 patients with biopsy-verified CD (equal to Marsh stage 3) through biopsy reports. Patients with CD were matched for age, sex, calendar period and county of residence with up to five reference individuals from the general population (n = 144,522). Cases of intussusception were identified from nationwide inpatient, hospital-based outpatient and day-surgery data from the Swedish Patient Register.Odds ratios (ORs) for future CD in patients with intussusception were estimated using conditional logistic regression.Results34 (0.12%) individuals with CD had a diagnosis of intussusception vs. 143 (0.10%) reference individuals, suggesting that intussusception was not a risk factor for later CD (OR = 1.17; 95% confidence interval (CI) = 0.82–1.67). The OR for CD in patients with at least two records of intussusception was 0.40 (95% CI = 0.06–2.99).In contrast, a post-hoc analysis showed that CD was associated with a statistically significantly increased risk of intussusception after CD diagnosis (hazard ratio = 1.95; 95% CI = 1.01–3.77); however, this analysis was based on only 12 cases with both CD and intussusception.ConclusionWe found no association between intussusception and future CD; and a mostly modest increased risk of intussusception after a diagnosis of CD.

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Early Vaccinations Are Not Risk Factors for Celiac Disease

Cited by 19 publications

References 38 publications

Early infections are associated with increased risk for celiac disease: an incident case-referent study

Early infections are associated with increased risk for celiac disease: an incident case-referent study

Primary Prevention of Celiac Disease: Environmental Factors with a Focus on Early Nutrition

A large nationwide population-based case–control study of the association between intussusception and later celiac disease

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