Elsevier

The Journal of Pediatrics

Volume 164, Issue 3, March 2014, Pages 463-467.e1
The Journal of Pediatrics

Original Article
Clinical, Serologic, and Histologic Features of Gluten Sensitivity in Children

https://doi.org/10.1016/j.jpeds.2013.10.007Get rights and content

Objective

To describe the clinical, serologic, and histologic characteristics of children with gluten sensitivity (GS).

Study design

We studied 15 children (10 males and 5 females; mean age, 9.6 ± 3.9 years) with GS who were diagnosed based on a clear-cut relationship between wheat consumption and development of symptoms, after excluding celiac disease (CD) and wheat allergy, along with 15 children with active CD (5 males and 10 females; mean age, 9.1 ± 3.1 years) and 15 controls with a functional gastrointestinal disorder (6 males and 9 females; mean age, 8.6 ± 2.7 years). All children underwent CD panel testing (native antigliadin antibodies IgG and IgA, anti-tissue transglutaminase antibody IgA and IgG, and anti-endomysial antibody IgA), hematologic assessment (hemoglobin, iron, ferritin, aspartate aminotransferase, erythrocyte sedimentation rate), HLA typing, and small intestinal biopsy (on a voluntary basis in the children with GS).

Results

Abdominal pain was the most prevalent symptom in the children with GS (80%), followed by chronic diarrhea in (73%), tiredness (33%), bloating (26%), limb pain, vomiting, constipation, headache (20%), and failure to thrive (13%). Native antigliadin antibodies IgG was positive in 66% of the children with GS. No differences in nutritional, biochemical, or inflammatory markers were found between the children with GS and controls. HLA-DQ2 was found in 7 children with GS. Histology revealed normal to mildly inflamed mucosa (Marsh stage 0-1) in the children with GS.

Conclusion

Our findings support the existence of GS in children across all ages with clinical, serologic, genetic, and histologic features similar to those of adults.

Section snippets

Methods

Our case series consists of 15 children with GS (10 males and 5 females; median age, 10.3 years; age range, 1.6-15 years) diagnosed at 2 pediatric gastroenterology centers at the University of Bari and University of Ancona in 2012-2013. These are tertiary referral centers for CD and other pediatric gastrointestinal disorders, each following up more than 800 children with CD. All children were referred to confirm/exclude an adverse food reaction to wheat ingestion. The suspicion of GS emerged

Results

All children with GS were referred to our attention because of a clear association between wheat consumption and symptoms, along with resolution after GFD. The hospital challenge produced early appearance of symptoms after gluten ingestion (median, 44 hours; range, 38-80 hours). Clinical characteristics of children with GS are summarized in Table II (available at www.jpeds.com).

Abdominal pain was the most frequent symptom, reported by 12 children (80%), followed by chronic diarrhea in 11 (73%);

Discussion

This series of children with GS supports the existence of this condition in children across all ages with clinical, serologic, genetic, and histologic features partially similar to those reported in adults. GS, a form of gluten intolerance in which neither allergic nor autoimmune mechanisms can be identified, is a recently described disorder that belongs to the spectrum of gluten-related disorders. Whether GS may include patients at the mild end of the celiac spectrum remains to be clarified.4

References (19)

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C.C. has received consulting fees from Menarini Diagnostics, Schär, and Heinz Italia. The remaining authors declare no conflicts of interest.

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