Vaccinations and Immune Response in Celiac Disease

Abstract

Immune response to vaccinations in celiac patients is of growing scientific interest. However, some aspects of the relationship between celiac disease (CD) and vaccines are still unclear. A comprehensive search of published literature using the PubMed database was carried out using the following key terms: “adaptive immunity”, “celiac disease”, “humoral immune response”, “immunization”, and “vaccination”. To date, there is no evidence showing any causative association between vaccines and CD development. Therefore, vaccinations may be administered according to the modalities and timing of the National Immunization Schedule for each country. The rotavirus vaccine is currently recommended for the general population, and according to some data, it appears to reduce the risk for the development of CD autoimmunity in the early years of life. Regarding the hepatitis B virus, a booster dose of the vaccine is often required due to the low or the lost immune response rate in CD. Furthermore, determination of hepatitis B antibody titers could be useful in newly diagnosed CD subjects regardless of age at diagnosis. Finally, pneumococcal vaccines may be administered in patients with advancing age at diagnosis and concomitant risk factors. Future clinical practice guidelines for vaccination and monitoring programs in celiac patients could be recommended.

COVID-19 Vaccine: A Survey of Hesitancy in Patients with Celiac Disease

“…Authors have also proposed to investigate splenic function in CD patients at high risk of hyposplenism (e.g., concomitant autoimmune disorders, old age at diagnosis, previous history of major infections/sepsis or thromboembolism, and/or spleen atrophy) [ 31 ]. Signally, CD appears to be the most frequent pathology associated with functional hyposplenism [ 16 , 32 , 33 ].…”

“…It is uncertain if CD patients have an increased risk of infection because of factors such as defective nutritional status, increased intestinal permeability, and hyposplenism [ 16 ], and if they have a lower immunogenic response to vaccination. Some inconclusive findings suggest that CD patients may develop lower immunogenicity after HBV vaccination [ 16 ].…”

“…It is uncertain if CD patients have an increased risk of infection because of factors such as defective nutritional status, increased intestinal permeability, and hyposplenism [ 16 ], and if they have a lower immunogenic response to vaccination. Some inconclusive findings suggest that CD patients may develop lower immunogenicity after HBV vaccination [ 16 ]. Misinformation on the internet and fake news about CD and vaccines can have a dramatic effect even though several scientific societies, including the Society for the Study of Celiac Disease, have clearly supported the administration of COVID-19 vaccines in the CD population [ 17 ].…”

Association between Elevated TGA-IgA Titers and Older Age at Diagnosis with Absence of HBV Seroconversion in Celiac Children

“…Despite the presence of multiple studies in the literature suggesting benefits to the administration of a booster dose [ 22 , 39 , 40 ], to the present date there seem to be no unequivocal indications concerning the practical management of these patients. Multiple studies advocate for the creation of a specific vaccination schedule in this population [ 35 , 42 ], with attention to the type of vaccination (intramuscular or intradermal) because some data [ 43 ] indicate that intramuscular administration yields better results that the conventional one. Intradermal administration promotes a dendritic-cell-mediated immune response, rather than the T-cell-mediated response elicited by an intramuscular administration—this strategy could be beneficial in non-responders, with the added advantage of requiring less antigen [ 44 ].…”

Response of Hepatitis B Vaccine in Children with Celiac Disease – An Experience at Ayub Teaching Hospital, Abbottabad Pakistan

“…6 Non-responders are often found to carry specific human leukocyte antigen (HLA) haplotype, including DR7, DR3, and DQ2. 7 Since the HLA-DQ2 haplotype is over-represented in celiac population, it seems reasonable to hypothesize that patients with Celiac Disease are less able to respond to HBV vaccine than the general population, whose frequency of HLA haplotype B8, DR3, and DQ2 are much lower. It has been postulated that this genetic profile may play a crucial role in predisposing celiac patients to a lower grade of immunization to hepatitis B vaccine.…”