Spontaneous Normalization of Anti-Tissue Transglutaminase Antibody Levels Is Common in Children with Type 1 Diabetes Mellitus

Waisbourd‐Zinman, Orith; Hojsak, Iva; Rosenbach, Yoram; Mozer‐Glassberg, Yael; Shalitin, Shlomit; Phillip, Moshe; Shamir, Raanan

doi:10.1007/s10620-011-2016-0

Cited by 61 publications

(62 citation statements)

References 38 publications

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“…The most sensitive and specific serological tests for CD include IgA antibodies against either tTG or EMA, and both IgA and IgG antibodies for DGP (14). It seems that detection of IgG isotypes of anti - tTG or anti - DGP does not augment sensitivity for CD diagnosis in the conditions with high titer IgA isotypes (15).…”

Section: Resultsmentioning

confidence: 99%

An Overview of Celiac Disease in Childhood Type 1 Diabetes

Shahramian

Bazi

Sargazi

2018

Int J Endocrinol Metab

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ContextCeliac disease (CD) is a common phenomenon in children with Type 1 diabetes (T1D). In the present review, we have discussed the pathogenesis, diagnostic biomarkers, risk factors, and prognosis of CD in the context of pediatric T1D.Evidence AcquisitionLiterature published in Web of Science, PubMed, Scopus, Google Scholar, and Cochrane Library were scrutinized up to the end of 2017. The keywords of celiac disease, Type 1 diabetes, children, and pediatric were used in different combinations.ResultsImmune cytotoxic reactions along with dampen immune regulatory functions contribute to CD in the context of pediatric T1D. Many children with simultaneous CD and T1D do not represent with the clinical signs of the enteropathy rendering a diagnostic challenge. The most common screening tests in these children are routine serological tests of CD, anti - endomysial, anti - transglutaminase, and anti - deamidated gliadin peptide antibodies. Typing for human leukocyte antigens of DQ - 2 and DQ - 8 may assist in the diagnosis of silent CD in children with T1D. The most significant shared non - HLA genetic loci of CD and T1D comprise CTLA - 4, TAGAP, IL - 18RAP, PTPN2, RGS1, SH2B3, CCR5. Interactions between these loci can be important in susceptibility to CD in T1D. Some new biomarkers have been suggested for diagnosis of CD including ischemia-modified albumin (IMA), soluble syndecan-1 (SSDC-1), regenerating gene Iα (REG-Iα), Neurotensin, and Zonulin, which can be useful for diagnosis and screening of CD in childhood T1D.ConclusionsOverall, active seropositive CD seems to be of clinical importance in T1D with significant impacts on the quality of life and predisposition to diabetes associated complications. It is important to detect CD in the context of T1D to prevent potential risks contributing to morbidities and mortalities associated with either CD or T1D.

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Section: Resultsmentioning

confidence: 99%

An Overview of Celiac Disease in Childhood Type 1 Diabetes

Shahramian

Bazi

Sargazi

2018

Int J Endocrinol Metab

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“…Furthermore, although the study by Barera et al (18) described a single EmA positivity, our study shows a persistent (at least twice) positivity of celiac autoimmunity and HLA typing consistent with CD predisposition. A more recent retrospective study of 738 children with T1DM reported anti-tTG antibody levels normalized in 35% of children consuming a gluten-containing diet (6).…”

Section: Discussionmentioning

confidence: 99%

“…From a medical perspective, numerous advantages may exist in screening asymptomatic patients with T1DM, including the potential of improving diabetes control and avoidance of long-term manifestations of CD (5). However, the observation that elevated levels of antitissue transglutaminase (anti-tTG) antibody may spontaneously normalize in children with diabetes, despite continued consumption of gluten (6) and the absence of symptoms in most of these patients (5), would suggest caution before starting a gluten-free diet (GFD) in a particularly delicate group of children already struggling with a complex chronic disease in whom the addition of a second limiting dietetic condition might be remarkably difficult in front of limited benefit (7).…”

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confidence: 99%

High Rate of Spontaneous Normalization of Celiac Serology in a Cohort of 446 Children With Type 1 Diabetes: A Prospective Study

et al. 2015

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OBJECTIVEIn children with type 1 diabetes mellitus (T1DM), elevated levels of antitissue transglutaminase (anti-tTG) antibody may spontaneously normalize, despite continued consumption of gluten. We aimed to investigate the prevalence of spontaneous normalization of anti-tTG levels and the existence of factors predictive for this outcome. RESEARCH DESIGN AND METHODSAll children referred from 2002 to 2012 were screened for celiac disease (CD) at diabetes onset and at specific intervals. In the presence of a high anti-tTG titer or clinical symptoms, children were offered endoscopy, and asymptomatic patients with a low anti-tTG titer were invited to a second serological test after 6 months of eating a gluten-containing diet. RESULTSThe study included 446 children. Of these, 65 (14.5%) became positive for celiac serology: 38 (58%) had a persistently elevated anti-tTG titer and 27 (41%) fluctuating anti-tTG titer; 18 (28%) became negative. The prevalence of positive CD autoimmunity and overt CD was 14.3% (95% CI 11-17) and 8.5% (95% CI 5-10), 15-and 8-times higher than the general pediatric population, respectively. Asymptomatic children older than 9.1 years at T1DM onset had the lowest risk to develop CD. CONCLUSIONSSerum anti-tTG levels decreased spontaneously in 40% of children with T1DM and became negative in 20%, despite gluten consumption. This finding supports the hypothesis of a state of temporary positivity of celiac serology in children with diabetes. In absence of clinical symptoms or signs of CD, histological confirmation of the disease and the gluten-free diet should be postponed to avoid unnecessary procedures and reduce an additional psychological burden.

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“…Analysis -There is a relationship between celiac disease and type 1 diabetes (72). The risk for type 1 diabetes is 5-to 20-fold higher in celiac patients than in the general population (73,74).…”

Section: Davis' Point -The Increase In Celiac Disease Parallels Incrementioning

confidence: 98%

Wheat Belly—An Analysis of Selected Statements and Basic Theses from the Book

Jones

2012

Cereal Foods World

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Spontaneous Normalization of Anti-Tissue Transglutaminase Antibody Levels Is Common in Children with Type 1 Diabetes Mellitus

Abstract: Physicians treating children with type 1 diabetes and mildly elevated anti-TTG antibody levels might consider 12-month serologic follow-up on a gluten-containing diet rather than immediate duodenal biopsy.

Cited by 61 publications

References 38 publications

An Overview of Celiac Disease in Childhood Type 1 Diabetes

An Overview of Celiac Disease in Childhood Type 1 Diabetes

High Rate of Spontaneous Normalization of Celiac Serology in a Cohort of 446 Children With Type 1 Diabetes: A Prospective Study

Wheat Belly—An Analysis of Selected Statements and Basic Theses from the Book

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