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  • Jefferson Adams
    Jefferson Adams
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    Can Rituximab Treat Recurrent Dermatitis Herpetiformis?

    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 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 biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided 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.

  • Related Articles

    Jefferson Adams
    Celiac.com 11/13/2013 - Dermatitis herpetiformis is the cutaneous manifestation of celiac disease. Both celiac and dermatitis herpetiformis are diseases of gluten-sensitivity.
    People with celiac disease, even with asymptomatic forms, often experience reduced bone density from metabolic bone disease. This led scientists to ask if dermatitis herpetiformis results in bone loss as celiac disease does.
    However, there is very little data about bone density in patients with dermatitis herpetiformis, so that question remained unanswered.
    To find an answer, a team of researchers recently set out to compare bone mineral density (BMD) of people with celiac disease against bone mineral density for dermatitis herpetiformis patients.
    The research team included K. Lorinczy, M. Juhász, M. Csontos, B. Fekete, O. Terjék, P.L. Lakatos, P. Miheller, D. Kocsis, S. Kárpáti, Z. Tulassay, and T. Zágoni.
    The team looked at 34 people with celiac disease, 53 with dermatitis herpetiformis, and 42 healthy people as a control group. The average patient age was 38.0 +/- 12.1 for the celiac disease group, 32.18 +/- 14.95 for the dermatitis herpetiformis group, and 35.33 +/- 10.41 years for the healthy control group.
    For each group, the team used dual-energy X-ray absorptiometry to measure bone mineral density of the lumbar spine, the left femoral neck and radius.
    The team defined low bone density, osteopenia and osteoporosis as a body mass density (BMD) T-score between 0 and -1, between -1 and -2.5, and under -2.5, respectively.
    In the lumbar region, the team found decreased BMD in 49% of the patients with dermatitis herpetiformis, in 62% of the patients with celiac disease, and in 29% of healthy control subjects.
    Overall, they measured lower BMD at the lumbar region in people with dermatitis herpetiformis and celiac disease than in the healthy subjects (0.993 +/- 0.136 g/cm2 and 0.880 +/- 0.155 g/cm2 vs. 1.056 +/- 0.126 g/cm2; p < 0.01).
    There was no difference in density of bones composed of dominantly cortical compartment (femoral neck) in dermatitis herpetiformis and healthy subjects.
    This study shows that low bone mass is common in patients with dermatitis herpetiformis, and that bone mineral density for these patients is significantly lower in those bones with more trabecular than cortical composition.
    Source:
    Rev Esp Enferm Dig. 2013 Apr;105(4):187-193.

    Jefferson Adams
    Could Nickel Play a Role in Contact Dermatitis in Cases with Non-Celiac Wheat Sensitivity?
    Celiac.com 02/20/2017 - Nickel is the most common cause of contact allergy, and nickel exposure can result in systemic nickel allergy syndrome, which mimics irritable bowel syndrome (IBS). Nickel is also found in wheat, which invites questions about possible nickel exposure from wheat in some cases of contact dermatitis. However, nickel hasn't really been studied in relation to glutenâ€related diseases.
    A research team recently set out to evaluate the frequency of contact dermatitis due to nickel allergy in NCWS patients diagnosed by a doubleâ€blind placeboâ€controlled(DBPC) challenge, and to identify the characteristics of NCWS patients with nickel allergy. The research team included Alberto D'Alcamo, Pasquale Mansueto, Maurizio Soresi, Rosario Iacobucci, Francesco La Blasca, Girolamo Geraci, Francesca Cavataio, Francesca Fayer, Andrea Arini, Laura Di Stefano, Giuseppe Iacono, Liana Bosco, and Antonio Carroccio.
    The are variously affiliated with the Dipartimento di Biologia e Medicina Interna e Specialistica (DiBiMIS), Internal Medicine Unit, University Hospital, Palermo, Italy; the Surgery Department, University Hospital, Palermo, Italy; Pediatric Unit, "Giovanni Paolo II" Hospital, Sciacca (ASP Agrigento), Italy; DiBiMIS, Gastroenterology Unit, University Hospital, Palermo, Italy; Pediatric Gastroenterology Unit, "ARNAS Di Cristina" Hospital, Palermo, Italy; Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (Ste.Bi.CeF), University of Palermo, Palermo, Italy.
    Their team conducted a prospective study of 54 women and 6 men, with an average age of 34.1 year, and diagnosed with NCWS from December 2014 to November 2016. They also included a control group of 80 age†and sexâ€matched subjects with functional gastrointestinal symptoms.
    Patients reporting contact dermatitis related to nickelâ€containing objects were given a nickel patch sensitivity test. The tests showed that six out of sixty patients (10%) with NCWS suffered from contact dermatitis and nickel allergy, and this frequency was statistically higher than observed in the 5 percent seen in the control group.
    Compared to NCWS patients who did not suffer from nickel allergy, NCWS patients with nickel allergy commonly showed a higher rates of skin symptoms after wheat consumption. Contact dermatitis and nickel allergy are more frequent in NCWS patients than in subjects with functional gastrointestinal disorders.
    Moreover, large numbers of these patients showed cutaneous manifestations after wheat ingestion. Nickel allergy should be evaluated in NCWS patients who have cutaneous manifestations after wheat ingestion.
    More study is needed to determine the relationship between nickel sensitivity and NCWS.
    Source:
    Nutrients 2017, 9(2), 103; doi:10.3390/nu9020103

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    Thank you for responding. No I have not been tested for celiac disease. My ths free t3 free t4 were all normal. My reverse t3 was a bit high and my tg antibodies were high. Also I have low blood pressure and low testosterone. The whole reason I went to see the doctor in the first place was because I had nausea and acid reflux for no apparent reason which I hve recently discovered is connected to hashimotos. I have just been to a dentist because I have untreated periodontal disease which we suspect may be causing everything. We are in the process of fixing that as well. So far the gluten free diet along with probiotics and L glutamine are helping a lot with the stomach issues.
    In my saga to get diagnosed, I had an IgA blood test (I had been eating gluten for a few months). It came back negative. I managed to see the dermatologist yesterday (woo hoo!) who said my rash is "consistent with DH" but he would not say it was DH. He did two punch biopsies which will be ready in about a week. My primary care sent me an email saying that because the IgA is negative, I do not have celiac disease. So hoping the biopsy shows something. Why will no one give me a diagnosis??? I'm going out of my mind. I do not want to go gluten free unless I have to because I already have several restrictions on what I can cook for my son with multiple food allergies, and wheat is a big part of his diet (he is allergic to peanuts, tree nuts, soy, eggs and sesame). I'm at my wits end.   Thanks for being so supportive everyone!
    According to the Celiac Disease Foundation, as many as 1 in 100 people suffer from celiac disease worldwide, an autoimmune disorder that attacks ... View the full article
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