Lung Disease / Asthma

The Gluten File

 
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!

An Informal Poll

(Delphi Celiac Forum - you many enter as guest)

Sites of Interest

Holistic Health Topics - Asthma

Canadian Asthma Prevention Institute (RAINS) 

Nutramed - Asthma

LEF - Asthma




PubMed Abstracts


Asthma

Pulmonary symptoms were improved on a gluten free diet suggesting a causal relationship between celiac disease and respiratory symptoms.
[Rhinopulmonary involvement in celiac disease: one case report]
PMID: 18603176  Feb 2008

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.
Probiotics in the atopic march: highlights and new insights.
PMID: 17259093  Dec 2006

These results indicate that food avoidance may help in asthma control in children.
Avoidance of food allergens in childhood asthma.
PMID: 15876598 April 2005

Could TH1 and TH2 diseases coexist? Evaluation of asthma incidence in children with coeliac disease, type 1 diabetes, or rheumatoid arthritis: a register study
PMID: 11692104 2001 Nov

Adult coeliac disease presenting with symptoms of worsening asthma.
PMID: 2877298

Juvenile diabetes mellitus, celiac disease and bronchial asthma. Simultaneous occurrence in a 4-year-old girl.
PMID: 7450645

Asthma as a paradigm for autoimmune disease.
PMID: 14646381

A case of cough, lymphocytic bronchoalveolitis and coeliac disease with improvement following a gluten free diet.
PMID: 11809998

Association between celiac disease and lung disease.
PMID: 6101248

GERD and Asthma

Gastroesophageal 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.
Gastroesophageal reflux, asthma, and mechanisms of interaction
.
PMID: 11749917

Gastroesophageal reflux (GER) is a factor often neglected in the etiopathogenesis of asthma. The estimated incidence of GER in asthmatic children reaches 50-60% and is higher than in the general population. GER may accompany typical symptoms: hoarseness, sore throat, thoracic pain, cough or wheezing. GER may not only aggravate the course of bronchial obstruction, but may also cause it, or trigger obstruction due to other factors. Asthma and GER coincidence has been acknowledged for many years.
Asthma and gastroesophageal reflux in children.
PMID: 11887043 (free full text available as download)

Sarcoidosis

Prevalence of coeliac disease in patients with sarcoidosis.
PMID: 15316417  Sept 2004

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.
Evidence of gastrointestinal immune reactivity in patients with sarcoidosis.
PMID: 10363754  May 1999

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.
[Celiac disease associated with cutaneous sarcoidosic granuloma]
PMID: 9500002  1997


These findings suggest that in patients with sarcoidosis, there is an altered gastrointestinal mucosal immune response, accompanied in about 40% of patients by specific sensitisation to wheat protein.
Altered gastrointestinal immune response in sarcoidosis.
PMID: 3265402  1998

Cystic Fibrosis 


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.]
PMID: 17620226   July 2007   

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.
Coexistence of cystic fibrosis and celiac disease. Description of a clinical case and review of the literature.
PMID: 10963013 Sept 1999

As no environmental factors were found to affect the phenotypic expression of the disease, genetic factors seem to play a major role. The presence of overt or latent celiac disease in three of the four siblings of the three concordant twins, and the association with cystic fibrosis in all three siblings of one of these families, further supports this hypothesis.
Gluten sensitivity in monozygous twins: a long-term follow-up of five pairs.
PMID: 10894587

The authors describe a case of association cystic fibrosis coeliac disease, which they have observed. The positive result revealed from the sweat-test and the study of genomic mutation (delta F508) showed the diagnosis of cystic fibrosis associated with coeliac disease. The specific treatment of both syndromes resolved intestinal alterations and caused the diminution of the acute bronchitis frequent during the first and the second infancy.
Celiac disease and cystic fibrosis: casual association?
PMID: 7791704

Pulmonary Hemosiderosis


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

Pulmonary haemosiderosis in a 13-year-old girl with coeliac disease after 3 months on a gluten-free diet: case report and review of the literature.
PMID: 20828461
  Sept 2010

We describe a patient with celiac disease associated with cardiomyopathy and pulmonary hemosiderosis.
Association of Celiac Disease with Cardiomyopathy and Pulmonary Hemosiderosis. 
PMID: 19897848 Nov 2009

A few good men: a Marine with hemoptysis and diarrhea. Idiopathic pulmonary hemosiderosis and celiac sprue. 
PMID: 18779201  Sept 2008

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.
Screening for celiac disease in idiopathic pulmonary hemosiderosis.
PMID: 18603390  July 2008

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.
Pulmonary Hemosiderosis in Association with Celiac Disease.
PMID: 17235730  Oct 2006

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.
Co-occurrence pulmonary haemosiderosis with coeliac disease in child.
PMID: 18406122 April 2006

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.
Serum histamine-releasing activity in a patient with idiopathic pulmonary haemosiderosis.
PMID: 11834189  Nov 2001

We believe that the concurrence of these two diseases is not coincidental, because a gluten-free diet had beneficial effects on the pulmonary symptoms not only in our case but also in other such patients
Immunological aspects of a child with idiopathic pulmonary hemosiderosis and celiac disease
PMID: 9871897 Nov 1998

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.
Bronchoalveolar lavage findings in a young adult with idiopathic pulmonary haemosiderosis and coeliac disease.
PMID: 8050533 May 1994

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

Tuberculosis

Coeliac disease and risk of tuberculosis A A population-based cohort study.
PMID: 17047199 Oct 2006