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  • Jefferson Adams
    Jefferson Adams

    Can Rituximab Treat Recurrent Dermatitis Herpetiformis?

    Reviewed and edited by a celiac disease expert.

    Caption: Image: CC--hazma butt

    Celiac.com 03/06/2017 - Dermatitis herpetiformis is an autoimmune skin-blistering disease which is commonly associated with celiac disease. The most common treatments are a gluten-free diet along with the addition of dapsone. DH that does not respond to either a gluten-free diet, or to dapsone, is treated with other immune-suppressing medications, but results have been mixed.

    Now, for the first time, a patient treated with rituximab therapy had resolution of both his pruritus and skin rash. "In addition, the levels of both anti-tissue and anti-epidermal transglutaminase antibodies normalized," said Dr. Ron Feldman of Emory University School of Medicine.

    Writing in JAMA Dermatology, Dr. Feldman and colleagues describe a man in his 80's with a five-year history of worsening DH. He was put on a gluten-free diet along with dapsone 50 mg daily, but his pruritic rash persisted. Dapsone was discontinued because of worsening anemia. He began treatment with 3 g sulfasalazine daily, but this was discontinued due to gastrointestinal symptoms. His disease worsened, and he was put on a tapering course of prednisone from 40 mg to 10 mg daily along with azathioprine titrated up to 2.5 mg/kg daily. However, his disease continued to worsen over subsequent months.

    He was then treated with rituximab according to the protocol used to treat lymphoma: four weekly infusions of 375 mg/m2. "Rituximab," says Dr. Feldman, "has already shown efficacy in the treatment of other autoimmune blistering diseases such as pemphigus and pemphigoid and may have relevance with other B cell mediated diseases in dermatology."

    Thirteen months after treatment, the patient experienced complete resolution of pruritus and other symptoms of DH, as well as normalization of antibodies against both epidermal and tissue transglutaminases.

    Not only was there a normalization of antibodies against both epidermal and tissue transglutaminases, the patient went into remission and has remained symptom-free for up to a year and a half thus far, said Dr. Feldman.

    There is some cause for excitement here, since rituximab is well tolerated and can potentially provide long lasting remission with removal of pathogenic autoimmune B cells.

    Dr. Feldman concedes that their patient did not have serious gastrointestinal symptoms, but remains "hopeful that rituximab may provide similar benefits for patients with celiac disease, in which anti-tissue transglutaminase antibodies play a role, although further research will need to be done to confirm this."

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    It was my understanding that my husband was the first person in the US to use Retux for NHL, its original use was for something else altogether. They gave him 6 months to a year and a half to live, Retux gave him 10 years more. I also know plenty of folks who died from using it, but they all had cancer. Hard to say how well it would be tolerated for this situation. I suppose if I were desperate enough, I might give it a go.

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    Dermatitis herpetiformis (ICD-10 cod L13.0) is described as; "Skin disease to which people are predisposed resulting from an immunological response to glen; see as an extremely pruitic eruption of various lesions that frequently heal, leaving hyper-pigmentation or hypo-pigmentation and scarring; usually associated with an asymptomatic gluten-sensitivity enteropathy." Even with a gluten-free diet there is often times exposure to gluten and gluten cross-reactors in processed foods and in food preparations. Yeast, egg and dairy are cross-reactors. I suggest that these items should also be removed from the diet in addition to gluten since the chemical structures are similar enough to gluten to trigger a reaction.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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