Lung Disease / Asthma
There are several lung diseases possibly associated with Celiac Disease/Gluten Sensitivity. According to the 2002 New England Journal of Medicine Review article on Celiac Disease, they might include sarcoidosis, cystic fibrosis, fibrosing alveolitis, lung cavities, and pulmonary hemosiderosis.
Asthma is commonly associated with celiac disease and gluten sensitivity, but unfortunately the supportive evidence is largely anecdotal.
In one informal poll taken on a popular celiac forum, 38% of the respondents reported complete resolution of asthma symptoms, and another 50% reported an improvement in symptoms after instituting a gluten free diet!
Sites of Interest
Pulmonary symptoms were improved on a gluten free diet suggesting a causal relationship between celiac disease and respiratory symptoms.
In clinical trials probiotics appear to be useful for the treatment of various clinical conditions such as food allergy, AD and allergic rhinitis, and in primary prevention of atopy. We can hypothesize that it may be possible, in the future, to use probiotics in primary prevention of asthma.
These results indicate that food avoidance may help in asthma control in children.
Could TH1 and TH2 diseases coexist? Evaluation of asthma incidence in children with coeliac disease, type 1 diabetes, or rheumatoid arthritis: a register study
GERD and Asthma
reflux (GER) is a potential trigger of asthma. The esophagus and lung
interact through a variety of mechanisms. Esophageal acid-induced
bronchoconstriction can be provoked by a vagally mediated reflex,
whereby acid in the distal esophagus produces airway responses; by
neural enhancement of bronchial reactivity, whereby esophageal acid
augments airway hyperresponsiveness; or by microaspiration, in which
small amounts of esophageal acid in the upper airway cause significant
airway responses. Interestingly, even in the microaspiration model, the
vagus nerve plays a significant role. Neurogenic inflammation in the
lung may occur with either vagally mediated mechanisms or with
microaspiration. The prevalence of reflux symptoms, esophagitis, and
abnormal esophageal acid contact time is higher in patients with asthma
than in control populations. Potential mechanisms, whereby asthma may
predispose to the development of GER, include autonomic dysregulation,
an increased pressure gradient differential between the thorax and the
abdomen, a high prevalence of hiatal hernia, alterations in crural
diaphragm function, and bronchodilator medication use. Further research
will help define how the esophagus and lung interact.
Prevalence of coeliac disease in patients with sarcoidosis.
CONCLUSION: We have demonstrated a high frequency of gastric autoimmunity and gluten-associated immune reactivity in patients with sarcoidosis, occurring in almost 40% of the cases, the former being the most frequent gastrointestinal immune manifestation.
The dermatological lesions improved during the following weeks with a gluten free diet and relapsed each time this diet was stopped. Many clinical associations with coeliac disease have been described with numerous visceral and skin-mucosa involvements. Eight cases of coeliac disease associated with sarcoidosis affecting the lung have been reported: in five cases, coeliac disease preceded sarcoidosis and in one case sarcoidosis relapsed each time gluten was reintroduced like in our case.
Patients diagnosed with untreated CD reported symptoms typical of both CF and CD (poor weight gain, loose and/or fatty stools, fatigue, irritability, abdominal pain). They improved after introduction of a gluten-free diet. CONCLUSIONS: Systematic screening for CD in a Scandinavian cohort of CF patients revealed a higher prevalence of CD than in the general population. Clinical signs of CD are difficult to differentiate from CF with malabsorption, and patients may go undiagnosed for a long time. In a population where CD is common we recommend screening for CD in patients with CF.
Co-morbidity of cystic fibrosis and celiac disease in Scandinavian cystic fibrosis patients.
PMID: 19303374 Mar 2009
[A 56-year-old man with cystic fibrosis and coeliac disease.]
Fifteen cases of such association have been previously described in literature, but only three have been genetically studied. The co-existence of cystic fibrosis and celiac disease in the same subject has to be considered till now a casual finding, but are also discussed hypothesis of a non-casual linkage, formulated by some authors.
Lane-Hamilton syndrome refers to the uncommon co-occurrence of idiopathic pulmonary hemosiderosis and celiac disease (CD). Three children aged between 7 and 14 years with IPH were detected to have co-existing non-diarrheal CD. Institution of gluten-free diet in each of the three children resulted in amelioration of the pulmonary symptoms along with improvement of anthropometric parameters and hemoglobin over a short-term follow-up period of 8-17 months. Inhaled/oral steroids and immunosuppressants could be weaned off after dietary exclusion therapy in each of the three children. Gluten free diet should be instituted in all patients diagnosed with Lane-Hamilton syndrome. It ameliorates both the pulmonary as well as the intestinal symptoms although the precise mechanism of the pulmonary response is as yet unclear.
Benefit of gluten-free diet in idiopathic pulmonary hemosiderosis in association with celiac disease.
PMID: 20967850 Oct 2010
We describe a patient with celiac disease associated with cardiomyopathy and pulmonary hemosiderosis.
Clinical and radiological findings improved markedly in all CD patients with corticosteroid treatment combined with a gluten-free diet. Symptoms of IPH and CD both returned in one patient who stopped the gluten-free diet. CONCLUSION: Three of our 10 patients with IPH also had CD. These data illustrate the close etiopathogenic link between IPH and CD, and strongly suggest that CD be looked for in IPH patients, especially in those with symptoms suggestive of CD.
A 15-year-old male had a history of increasing dyspnea on exertion, cough, sputum production, fever, weakness, hemoptysis, and diarrhea. Chest radiography demonstrated bilateral alveolar consolidation. Bronchoalveolar lavage fluid analysis revealed extensive hemosiderin-laden alveolar macrophages. On the basis of iron deficiency anemia, diarrhea, raised antigliadin and antiendomysial antibodies, widespread villous atrophy, and crypt hyperplasia on intestinal biopsy, celiac disease was diagnosed. After treatment with a gluten-free diet, all his clinical symptoms and radiographic findings improved within two weeks.
The chest X-rays showed unilateral alveolo-intertitial infiltrate. Broncho-alveolar lavage revealed 70% haemosiderin-laden macrophages. The diagnosis of IPH was made. Since severe anaemia is disproportionate to radiologic findings, searching associated CD was performed and then confirmed by biological and histological examinations. A gluten-free diet was initiated. Evolution was favourable. Looking for especially CD in IPH should be systematic, even in the absence of gastrointestinal symptoms.
Coeliac disease as a cause of unusually severe anaemia in a young man with idiopathic pulmonary haemosiderosis.
PMID: 15763451 April 2005
PMID: 15334514 Oct 2004
The pathogenesis of the diseases is unclear, although an association with milk or gluten hypersensitivity has been described, and an immune-mediated damage of alveolar capillaries has been suggested. A previous report showed the release of histamine after cow's milk intake in a newborn with cow's milk intolerance and IPH.
PMID: 7994352 June 1994
Both clinical and immunological improvement was obtained after a month of gluten-free diet. These immunological findings provide new insight into the pathogenesis of this disease.
Firm evidence of a causal relationship between the two diseases is lacking but treatment with a gluten-free diet alone apparently had beneficial effects on the lung disease in two patients. Patients with idiopathic pulmonary hemosiderosis should routinely have tests for gluten intolerance, for instance a lactulose-mannitol intestinal permeability test. Lastly, other concomitant food allergies are reported.
The association of pulmonary hemosiderosis and celiac disease. Apropos of a new case in a child
PMID: 1570946 Mar 1992
The patient has been asymptomatic for four years on a gluten-free diet. In cases of IPH, it may be important to investigate the coexistence of CD because treatment of the latter could lead to a better prognosis.
Long-term clinical follow-up of adult idiopathic pulmonary hemosiderosis and celiac disease.
PMID: 2036845 June 1991
A child with idiopathic pulmonary haemosiderosis for three years required three monthly transfusions. Circulating avian, gliadin, and reticulin antibodies suggested the diagnosis of gluten enteropathy, and jejunal biopsy showed subtotal villous atrophy. During 15 months on a gluten free diet his growth and behaviour improved and he required no transfusions.
Pulmonary haemosiderosis and gluten.
PMID: 3606190 May 1987
Small bowel biopsies were performed in seven patients in whom a diagnosis of idiopathic pulmonary haemosiderosis had been made. Villous atrophy was present in three patients and convoluted villi in one. There was no correlation between gastrointestinal symptoms or routine blood tests and abnormality of the small bowel mucosa. Three of the four patients with abnormal mucosa had HLA B8 antigen and the three patients with villous atrophy responded to gluten withdrawal.
Adult idiopathic pulmonary haemosiderosis and coeliac disease.
PMID: 7267971 1981
Coeliac disease and risk of tuberculosis A A population-based cohort study.