1. Cytokine release after gluten ingestion differentiates coeliac disease from self-reported gluten sensitivity.
- Author
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Tye-Din JA, Skodje GI, Sarna VK, Dzuris JL, Russell AK, Goel G, Wang S, Goldstein KE, Williams LJ, Sollid LM, Lundin KE, and Anderson RP
- Subjects
- Adult, Aged, Australia, Bread adverse effects, Celiac Disease blood, Celiac Disease diet therapy, Celiac Disease immunology, Cytokines immunology, Diagnosis, Differential, Female, Food Hypersensitivity blood, Food Hypersensitivity diet therapy, Food Hypersensitivity immunology, Glutens immunology, Humans, Male, Middle Aged, Self Report, Young Adult, Celiac Disease diagnosis, Cytokines blood, Diet, Gluten-Free, Food Hypersensitivity diagnosis, Glutens administration & dosage
- Abstract
Background: Diagnosing coeliac disease (CD) in patients on a gluten-free diet (GFD) is difficult. Ingesting gluten elevates circulating interleukin (IL)-2, IL-8 and IL-10 in CD patients on a GFD., Objective: We tested whether cytokine release after gluten ingestion differentiates patients with CD from those with self-reported gluten sensitivity (SR-GS)., Methods: Australian patients with CD ( n = 26) and SR-GS ( n = 18) on a GFD consumed bread (estimated gluten 6 g). Serum at baseline and at 3 and 4 h was tested for IL-2, IL-8 and IL-10. Separately, Norwegian SR-GS patients ( n = 49) had plasma cytokine assessment at baseline and at 2, 4 and 6 h after food bars containing gluten (5.7 g), fructan or placebo in a previous double-blind crossover study., Results: Gluten significantly elevated serum IL-2, IL-8 and IL-10 at 3 and 4 h in patients with CD but not SR-GS. The highest median fold-change from baseline at 4 h was for IL-2 (8.06, IQR: 1.52-24.0; P < 0.0001, Wilcoxon test). The two SR-GS cohorts included only one (1.5%) confirmed IL-2 responder, and cytokine responses to fructan and placebo were no different to gluten. Overall, cytokine release after gluten was present in 22 (85%) CD participants, but 2 of the 4 non-responders remained clinically well after 1 y on an unrestricted diet. Hence, cytokine release occurred in 22 (92%) of 24 'verified' CD participants., Conclusions: Gluten challenge with high-sensitivity cytokine assessment differentiates CD from SR-GS in patients on a GFD and identifies patients likely to tolerate gluten reintroduction. Systemic cytokine release indicating early immune activation by gluten in CD individuals cannot be detected in SR-GS individuals.
- Published
- 2020
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