House CallFeb/Mar 2013 Issue

Research Roundup: Celiac Cure, Beneficial Bacteria, and More!

© federicofoto/123RF

© federicofoto/123RF

Celiac is Ancient

Archaeologists in Tuscany, Italy, found the remains of a first century AD teenager who may have had celiac disease. The teen, a female, appeared severely malnourished and showed other signs suggestive of celiac disease: short stature, osteoporosis, dental enamel defects and cribra orbitalia, a bone condition that researchers think may be an indirect sign of anemia. Food scarcity was unlikely since the overall quality of the teen’s tomb, as well as her jewels, indicate she came from a wealthy family.

When researchers analyzed her DNA (extracted from bone and teeth), they found she carried the genetic risk for celiac. Like approximately 90 percent of celiacs today, she was DQ2 positive. Genetic markers DQ2 and DQ8 are associated with celiac disease.

Researchers say the teen’s ancient remains strengthen the case that celiac disease has been part of human history for millennia—perhaps since wheat was introduced as food.

The finding was published in October 2012 in World Journal of Gastroenterology.

Celiac Cure

Researchers from the University of Pavia in Pavia, Italy, say two celiacs appear to be cured of their autoimmune condition after receiving a type of transplant known as an allogenic hematopoietic stem cell transplant. Both patients—a teenage girl and a school-age boy—were diagnosed with celiac disease before the transplant, which was performed to treat thalassemia, a genetic blood disorder. One year post-transplant, under their doctor’s care, both patients resumed a gluten-containing diet. During five years of follow-up, there was no return of celiac symptoms and celiac blood work remained normal. Although intestinal biopsies showed no signs of gluten-related damage at one and two years after reintroducing gluten, biopsies weren’t repeated at the five-year mark, which researchers say would help confirm a cure.

Stem cell transplants may restore “the ‘right’ balance between tolerance and immunity,” the researchers explain. However, transplants carry significant risks, such as graft-versus-host disease.

The work was published in October 2012 in the Journal of Pediatric Gastroenterology and Nutrition.

Clues to Food Allergy

There may be an important link between the health of the liver early in life and food allergy, according to British researchers. They found toddlers with severe liver disease, requiring a liver transplant, appeared to have a high rate of food sensitization. Of 50 tots who underwent a liver transplant between 2001 and 2008 at King’s College Hospital in London, 70 percent were sensitized to cow’s milk, egg and/or peanut. After transplant, just 36 percent were sensitized. Additionally, researchers observed those with more severe liver disease also had higher total IgE antibody levels. Making IgE antibodies (sensitization) is the first step toward developing allergy but allergy doesn’t always result.

Researchers say their findings may provide clues as to how food allergy happens and how it may be prevented. Whether less severe liver abnormalities early in life may be a risk factor for food sensitization should be explored in future studies, they add.

The work was published online in October 2012 in Pediatric Allergy and Immunology.

Beneficial Bacteria

Taking probiotics during pregnancy and while breastfeeding significantly reduced the risk of eczema in babies, according to a study from Turku University Central Hospital in Finland. Researchers there randomly assigned 241 pregnant women to take a daily vitamin or a vitamin-plus-probiotic supplement. All the women had a history of allergic conditions, including eczema, asthma and/or food allergies. At two years of age, just 10 percent of babies born to mothers given vitamins and probiotics had chronic eczema compared to 26 percent in the vitamin-only group.

Although promising, researchers say more work is needed, including studies on the most effective probiotic or combination of probiotics. Exactly when expectant mothers should start taking probiotics (and how long to continue) is another area for future research. Of note, researchers found probiotics appeared to have no impact on sensitization to food allergens or food allergy in the infants.

The study was published online in October 2012 in the Journal of Allergy and Clinical Immunology.

Food Allergy in Autism

Parents and teachers reported improvements in the behavior of autistic children at both eight weeks and six months after removing foods identified through skin-prick testing as allergenic to them. A team from the Islamic Azad University in Iran led the study, which involved testing for ten common food allergens in 39 children enrolled at the Noor Hedayat Center of Autism Spectrum Disorders. Three children (about 8 percent) had positive results; two subsequently removed peanuts from their diet while the third eliminated egg whites and oranges.

Although researchers don’t recommend routine allergy testing—their study was small and parents and teachers oversaw the dietary intervention and scored behaviors afterward, potentially influencing results—they call for further investigation into the potential relationship between food allergy and the behaviors of children with autism. The findings were published in October 2012 in Reports of Biochemistry & Molecular Biology.

Milk Wheal Size

Many milk-allergic children can safely eat foods with baked milk. But there’s been little data to help predict which children are likely to pass a baked milk challenge, indicating the food is safe. Now researchers at Boston Children’s Hospital say a helpful gauge may be the wheal size (swelling) that results from a skin-prick test with milk protein.

When they analyzed the outcomes of 35 children who underwent baked milk challenges, those with a milk wheal less than 12mm were more than 90 percent likely to pass. When the milk wheal was less than 7mm, no child failed.

During a food challenge, the suspect food is eaten in gradually increasing amounts to see if it’s tolerated. Because the challenge always carries the risk for a severe allergic reaction, it must be performed by trained healthcare professionals in a controlled setting.

The study was published in November 2012 in the Annals of Asthma, Allergy and Immunology.

Fast-Tracked Celiac

A drug that has the potential to become the first non-dietary treatment for celiac disease received Fast Track designation by the FDA this past fall. Fast Track gives the drug manufacturer more opportunity for interaction with the FDA as they continue with clinical trials. This can cut down the time to FDA approval.

The drug, ALV003, is a combination of two enzymes designed to target and break down gluten, reducing its ability to set off an immune response in those with celiac. Currently ALV003 is being developed for use as a companion to the gluten-free diet—to help guard against cross-contamination. Larazotide Acetate, a second drug being studied as a non-dietary treatment for celiac disease, also has Fast Track status.

Medical writer Christine Boyd lives in Baltimore.

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