Failure to Respond to Hepatitis B Vaccine in Children With Celiac Disease

Abstract

Background: Although IgA endomysial antibodies (EMA) and tissue transglutaminase (TG) are sensitive and specific serologic tests for the diagnosis of celiac disease, there is limited information on the association of the magnitude of antibody level with the severity of the histological abnormalities of the intestine. Purpose: To determine if EMA and TG titers correlate with the severity of histological changes in patients with celiac disease. Methods: We identified 148 children from our laboratory database that had EMA, TG and intestinal biopsies performed. IgA EMA was determined by indirect immunofluorescence with results expressed as a dilutional titer with positivity determined at 1:5. IgA TG was determined by an enzyme linked human immunosorbent ELISA assay with results expressed in standardized units. A modified Marsh histological grading system was used to describe the duodenal biopsies: Type 0 normal, I increased intraepithelial lymphocytes (IEL), II hyperplastic crypts, IIIa partial villus atrophy, IIIb subtotal villus atrophy, IIIc total villous atrophy. Results: Mean values for EMA (Table 1) and TG (Table 2) progressively increased with increasing Marsh score. Conclusion:There was considerable variability in EMA and TG levels for each Marsh grade, so that an individual level could not be utilized to predict histological severity. The data show that as a group, increasing severity of the histological lesion in celiac disease was associated with increased levels of both IgA EMA and TG antibodies.

Protective Antibody Responses to Influenza A/H1N1/09 Vaccination in Children With Celiac Disease

“…Certain studies have reported diminished responses of patients with CD to HBV, and attributed this to HLA-DQ2, -DR3, and -DR7 serotypes (2,3). These serotypes (particularly DQ2) are strongly associated with CD, and have been independently linked to the nonresponse to HBV, especially if present in homozygous form (2,3). In our study, DQ2 homozygotes responded equally well as heterozygotes; therefore, we cannot confirm any hypothesis linking diminished immune responses to the DQ2 zygosity.…”

“…Evidence about tetanus vaccine is conflicting (2,8), and immune responses to oral polio vaccine may be stronger in patients with CD (9).…”

“…In addition, patients with CD seem to have weaker humoral responses to certain immunizations, such as hepatitis B vaccine (HBV) (2,3). To our knowledge, no data describe the response of patients with CD to influenza vaccination.…”

The response to hepatitis B vaccine: does it differ in celiac disease?

“…More than 95% of celiac patients share one of HLA class II molecules, namely, HLA DQ2, DR3, and B8 haplotypes [14][15][16]. Recently, it has been shown that more than half of the children with CD did not show a response to the standard HBV vaccination, and the rate of nonresponse to HBV vaccine has been reported to be even higher when the adult celiac patients are concerned [17,18]. However, there are few studies addressed to the link between CD and hepatitis B vaccine nonresponse in celiac children [18].…”

“…Recently, it has been shown that more than half of the children with CD did not show a response to the standard HBV vaccination, and the rate of nonresponse to HBV vaccine has been reported to be even higher when the adult celiac patients are concerned [17,18]. However, there are few studies addressed to the link between CD and hepatitis B vaccine nonresponse in celiac children [18]. The aim of this study is to assess the response to HBV vaccine prospectively in a group of CD who were on a gluten-free diet (GFD) and to inquire the potential link between CD and hepatitis B vaccine nonresponse by studying shared HLA haplotypes.…”