House CallAug/Sep 2012 Issue

Research Roundup: Thyroid Check, Responsible for Anaphylaxis, and More!

The latest medical news for people with allergies and food sensitivities

Photo © skynesher/iStockphoto

Photo © skynesher/iStockphoto

Thyroid Check

A link between celiac disease and autoimmune thyroid diseases is well established. Now a study published in January in the Scandinavian Journal of Gastroenterology says the gluten-free diet doesn’t appear to reverse the progression of autoimmune thyroid disease.

Out of 27 patients newly diagnosed with celiac disease, mostly adult women, ten had thyroid disease at diagnosis (that’s compared to three of 27 in the non-celiac comparison group). One year later, despite strict dietary adherence, thyroid volume shrank in those with celiac disease and thyroid disease. Additionally, titers of the antibody, TPO-ab, which indicates an ongoing autoimmune process in the thyroid, continued to rise.

Results suggest that celiac patients may develop autoimmune thyroid disease even while maintaining a strict gluten-free diet, says the Tampere University Hospital (Finland) research team, adding that thyroid function tests and antibodies should be checked periodically in the follow-up treatment of celiac patients.

Responsible for Anaphylaxis

Kids are old enough to begin sharing responsibilities with parents for their anaphylaxis allergy by age 12 to 14, according to a survey of pediatric allergists. This responsibility includes recognition and management of allergic symptoms.

According to the 88 allergists surveyed (all members of the American Academy of Pediatrics’ section on allergy and immunology), there are many factors to consider for each individual before transferring responsibilities, however. These factors include the ability to demonstrate auto-injector technique, the ability to describe some anaphylaxis symptoms and the child’s overall developmental level.

“Parents should discuss the issue of sharing responsibility (not total responsibility) of recognizing and treating allergic reactions with their child and with their allergist,” says Scott Sicherer, MD, study co-author and professor of pediatrics at Mount Sinai School of Medicine in New York. “It makes sense to start discussions of shared responsibility early, since there needs to be a progression of learning and shared responsibility that’s related to the child’s abilities, comfort level and other individual circumstances.”

The study was published in May in the Annals of Allergy, Asthma and Immunology. Researchers from the Hospital for Sick Children in Toronto and the University of Manitoba in Winnipeg, Canada, also took part in the study.

Proper Testing

When testing for allergies, including food allergies, the American Academy of Allergy, Asthma and Immunology (AAAAI) advises against the use of immunoglobulin G (IgG) tests. It also cautions against using an “indiscriminate battery” of immunoglobulin E (IgE) tests. These evidence-based recommendations are part of a larger initiative called Choosing Wisely, designed to help patients and physicians make wise choices regarding the diagnosis and treatment of allergies, asthma or immunologic diseases.

According to AAAAI, specific IgG testing is not a test for an allergic condition (IgG measures exposure, not allergy). Instead, AAAAI states that “appropriate diagnosis and treatment of allergy requires specific IgE (skin or blood) testing guided by the patient’s history and physical examination.” Read more at aaaai.org.

Celiac News

Dozens of new studies on celiac disease were presented at Digestive Diseases Week (DDW), a medical meeting held in May in San Diego.

Research from the Central Scientific Research Institute of Gastroenterology in Moscow found the frequency of biopsy-proven celiac disease in 217 women with recurrent miscarriage or infertility was 3.2 percent. (High rates of undiagnosed celiac disease in women suffering from recurrent miscarriage and unexplained infertility have been previously reported). In this study, several of the celiac women went on to deliver healthy, full-term newborns after treatment with the gluten-free diet. As a result, researchers concluded, “serological screening could be routinely performed in women with reproductive disorders as a potential useful strategy to treat the same disorders and to allow for an early diagnosis of those all too often unrecognized cases of celiac disease.”

A second study also called for celiac screening, this time in individuals with alopecia areata (AA), an autoimmune disease that causes hair loss. Using blood samples from 99 individuals with AA, researchers from Columbia University in New York discovered a higher prevalence of celiac-associated antibodies in those with AA compared to the general population—9 and 3 percent, respectively. Celiac antibodies were more likely to be present in those with more severe forms of AA, involving total and/or long-term hair loss. Individuals with the least severe form of AA, with transient hair loss lasting less than a year, did not appear to have an elevated risk for celiac disease.

Lastly, also out of Columbia University, a team from the Celiac Disease Center investigated whether manufacturers of gluten-free foods routinely test for gluten content. Of 72 food manufacturers they contacted, the majority reported testing for gluten—87.5 percent. However, the tests being used varied and a third of companies said they didn’t know which test was employed. According to researchers, the most accurate tests for gluten content include the Standard R5 ELISA and Competitive R5 ELISA. Other tests have not been validated and may overestimate or underestimate gluten content, they report.

Fall Birth and Food Allergy

According to new research from the Johns Hopkins School of Medicine, tots born in the fall—September, October or November—are up to twice as likely to develop food allergy as those born during other seasons. The greatest risk was found in Caucasian children and those with eczema, pointing to the possibility that vitamin D and the skin barrier may be implicated in seasonal associations with food allergy.

Results were published online in April in Allergy. Whether vitamin D supplementation might modify the risk of food allergy was beyond the scope of the investigation.

Medical writer Christine Boyd lives in Baltimore.

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