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    Dermatitis Herpetiformis: Diagnosing and Treating the "Gluten Rash"


    Miranda Jade
    Image Caption: Photo: CC - Anosmia

    Celiac.com 04/25/2012 - In my experience growing up with undiagnosed celiac disease, I had to deal with several symptoms that my doctors had no answers for. One of the most frustrating of these was my skin troubles—dermatitis herpetiformis. After my experiences with misdiagnoses, and finally more recently, learning how to effectively get rid of dermatitis herpetiformis, I encourage parents to be particularly watchful for signs of dermatitis herpetiformis in their children, and I have some useful advice for those—children and adults—who have already been diagnosed with this annoying and sometimes quite troublesome rash. Since dermatitis herpetiformis occurs in 15 to 20% of celiacs, it’s worth any celiac’s time to learn more about this condition.


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    Photo: CC - AnosmiaBy definition, dermatitis herpetiformis is a blistering and extremely itchy skin rash. It’s usually symmetrical in shape and is most commonly located on the elbows, knees, buttocks, and upper back. It’s common for people with dermatitis herpetiformis to have rashes appear in the same spot, and they can either be consistent or come and go. People can experience the rash on other parts of the body, and severity of symptoms can vary. Dermatitis herpetiformis is sometimes called the “gluten rash” or “celiac disease rash” because it occurs in people with a gluten intolerance or celiac disease. It is commonly misdiagnosed as eczema.

    Gluten is a protein found in wheat, barley, and rye. In people who have celiac disease, gluten causes an autoimmune response which results in the immune system attacking the lining of the small intestine—specifically the villi, the absorptive hair-like structures of the lining. With dermatitis herpetiformis, outbreaks are also triggered by gluten.

    Interestingly, unlike celiac disease which appears more in women than men, dermatitis herpetiformis is more commonly found in men by a ratio of about two-to-one. It is rarely seen in children under ten and first appears in the teenage years or even in one’s twenties or thirties. It may come and go, even if you’re eating a gluten-containing diet.

    Diagnosis is done with a skin biopsy. In most cases, a dermatitis herpetiformis diagnosis means celiac disease as well, even if you’re not obviously suffering from the characteristic intestinal symptoms of this disease. No matter what, the treatment is the same: a strict gluten-free diet.

    Dermatitis herpetiformis rashes are treated in two main ways--the gluten-free diet, of course, and antibiotics such as dapsone or sulfapyridine for those who aren’t able to tolerate dapsone. A truly gluten-free diet can eliminate dermatitis herpetiformis, but in my experience and according to the National Institutes of Health, a dermatitis herpetiformis rash responds dramatically to dapsone, within 48 to 72 hours. To treat the underlying cause of dermatitis herpetiformis, which is celiac disease, a strict gluten-free diet must be followed, but according to the National Institutes of Health, “Even with a gluten-free diet, dapsone or sulfapyridine therapy may need to be continued for 1–2 years to prevent further dermatitis herpetiformis outbreaks.”

    As a celiac with dermatitis herpetiformis, completely eliminating gluten from my diet has been the only lasting solution for dermatitis herpetiformis, but unfortunately I can accidentally ingest gluten from time to time, especially when I travel. In my most recent outbreak, I decided to get a prescription for dapsone. Although dapsone is a very strong drug with side effects and should be used sparingly, I was in need of something fast-acting. I followed the instructions exactly, and not only did it relieve the pain but within three days, I could see a remarkable change in the appearance of the dermatitis herpetiformis. After reexperiencing the painful and frustrating symptoms of dermatitis herpetiformis and the relief that came with proper treatment, I knew I had to address this topic to help others. I encourage everyone to get the word out about dermatitis herpetiformis so more and more people dealing with this misdiagnosed condition can get help just as I did.

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    Guest beverly lees

    Posted

    I too have a big rash on my leg and have tried everything under the sun to get rid of it, even bleach. My doctor said it was only a skin rash but whenever it comes it itches so bad when I have jeans on because my legs get hot and there it goes--I'm scratching again.

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    I have used Dapsone Cream with great success rather than taking oral Dapsone. Really worth the time to have the cream made up at a special pharmacy.

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    Guest Pamela

    Posted

    I was misdiagnosed for 41 years and work in the healthcare field, my dermatologist had no idea what my rash was, had she known I would have been diagnosed 20 years sooner, I printed out material on Dematitis Herpetiformis from the internet and send it to her.

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    Guest Hilary Adams

    Posted

    I basically diagnosed myself with DH and found dapsone. I use it sparely and only with an outbreak. My information 10 years ago was that you can stop the itching and burning quickly and it works! If you are itching and can't stand it (no kidding!) one dose (I use 50 mg) will stop the itching within 30 minutes. I can usually get away with just one dose unless the outbreak is severe or the hidden gluten a large amount. Thanks for bringing it up!

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    Guest hans

    Posted

    I have used Dapsone Cream with great success rather than taking oral Dapsone. Really worth the time to have the cream made up at a special pharmacy.

    Can you tell me what kind of dapsone cream that you used and what's the difference between the oral and the topical cream? I am afraid of its side effects since I've been taking lots of different drugs caused of misdiagnosed in the past one year. Thanks.

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    Guest oscar

    Posted

    Check for scabies. I had something similar and waited a month before the second doctor I saw said it could be scabies. They gave me a cream prescription and now I am getting way better.

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    Guest Joe Eustis

    Posted

    My dermatitis herpetiformis manifestation began at age 64 and it took my dermatologist one year to finally diagnose it. Dapsone initially did the job, but it is very dangerous as it causes anemia by destroying your red blood cells. After about 6 months on Dapsone (and recovering from prostate cancer surgery), the Dapsone lost its effectiveness. One year after the dermatitis herpetiformis diagnosis, I was diagnosed with celiac disease and began the gluten-free diet. The rash continued to flare up and really got worse when I began taking Synthroid for low thyroid. I suspected the iodine was aggravating the dermatitis herpetiformis. A desperation visit to renowned dermatologist, Dr. John Zone (Salt Lake City), confirmed that a small percent of us dermatitis herpetiformis folks are also sensitive to iodine and must reduce iodine intake for a while. After about 2 years on the gluten-free diet and watching my iodine intake, I am doing much better. This information has helped another iodine sensitive dermatitis herpetiformis member of our local New Orleans CSA chapter.

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    My dermatitis herpetiformis manifestation began at age 64 and it took my dermatologist one year to finally diagnose it. Dapsone initially did the job, but it is very dangerous as it causes anemia by destroying your red blood cells. After about 6 months on Dapsone (and recovering from prostate cancer surgery), the Dapsone lost its effectiveness. One year after the dermatitis herpetiformis diagnosis, I was diagnosed with celiac disease and began the gluten-free diet. The rash continued to flare up and really got worse when I began taking Synthroid for low thyroid. I suspected the iodine was aggravating the dermatitis herpetiformis. A desperation visit to renowned dermatologist, Dr. John Zone (Salt Lake City), confirmed that a small percent of us dermatitis herpetiformis folks are also sensitive to iodine and must reduce iodine intake for a while. After about 2 years on the gluten-free diet and watching my iodine intake, I am doing much better. This information has helped another iodine sensitive dermatitis herpetiformis member of our local New Orleans CSA chapter.

    Thank you. This the information I was looking for. Do you still take Synthroid or another brand?

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    Guest Kathryn

    Posted

    Check for scabies. I had something similar and waited a month before the second doctor I saw said it could be scabies. They gave me a cream prescription and now I am getting way better.

    Trust me, it's not scabies. If you have DH, you know it's different from anything else.

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    Hi, thanks so much for posting this! I have celiac disease and a rash that looks like DH on my elbows but my doctor took a biopsy and says it's not DH it's "urticaria". I'm confused because, from what I understand urticaria simply means "hives" yet the symptoms I'm experiencing in relation to my "hives" are that of DH, so I wonder if this is a misdiagnosis... were your hives at first misdiagnosed? Thanks!

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    Hi, thanks so much for posting this! I have celiac disease and a rash that looks like DH on my elbows but my doctor took a biopsy and says it's not DH it's "urticaria". I'm confused because, from what I understand urticaria simply means "hives" yet the symptoms I'm experiencing in relation to my "hives" are that of DH, so I wonder if this is a misdiagnosis... were your hives at first misdiagnosed? Thanks!

    Hi, I just found I have DH 3 days ago, I've been having skin problems for almost year and a half. My first dermatologist told me it was ring worm, second one that it was impetigo. Third dermatologist took a couple of skin samples and the biopsy shown it was DH. I have some GI problems and I'm going on gluten free diet, but I've been reading a lot about cross reactive foods to gluten and it worries me a bit. Do you find this food harmful or do you just skip wheat, rye and barley?

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    Guest s.middleton

    Posted

    My daughter who is 4 years old was recently diagnosed with DH. She had caught chicken pox and after 2 weeks of having it we took her to the doctors only to be told that it was normal to last this long. After 6 weeks we returned to the doctors who told us it was bites. 4 weeks later we returned yet again and this time admitted to hospital. The doctor tested her for chicken pox, which was positive, but also tested her for DH, even though the dermatologist said it was highly unlikely. Well it came back positive. After looking on the internet of pictures of the rash I believe my daughter had it when she was just 7 months old and was misdiagnosed. I am left feeling let down and guilty that I have let my daughter down. She is due to have an endoscopy next week to confirm celiac.

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    I have had a rash on my shoulder, neck, and shin area for a year! My doc said it was dermatitis-- My dermo asked me if I was dying my hair. Both prescribed cortisone lotion and suggested a cortisone shot. The PA put gloves on; the doc did not. When I went to Ireland for three weeks the rash disappeared which further suggests American wheat is bad news. When I got back the rash reappeared within a week: burning, itching. I am on my 4th doc and she continued the cortisone lotion and wants me to go back to my dermo to have a culture/biopsy. The bumps/welts look just like the pics for DH. Finally, I may have it figured out. I have suspected gluten sensitivity due to headaches etc. but did not know it could cause DH.

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    Guest Marlene

    Posted

    Very good information. Thanks very much.

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    Guest Rachel

    Posted

    People, please inform and advocate for yourselves and loved ones. There are too many doctors who are completely uninformed and non-experienced with DH. I have been suffering from dermatitis herpetiformis/DH since the start of fall 2013 and have seen a total of 4 doctors all of whom seemed to have no experience or knowledge of what I was experiencing and all wanted to treat the symptoms with cream rather than confirm the cause.

    Even when I told each of them I went gluten free for 2 whole months and the DH went away, even when I showed them pictures of the rashes' progression starting/prior to scratching, full blown after scratching and as it was in retreat, they all gave conflicting explanations such as dermatitis, eczema, and "allergy." I knew much more than all of them COMBINED but since they hold the degrees and the prescription pads, they stuck to their lack of DH and kept the Dapsone to themselves despite my suffering and refused even a 2 or 3 day course for diagnosis like some doctors that I keep hearing about apparently do. WHY oh WHY could I not have found one of those doctors????

    After much investigating on my own, I am going to be seeing an allergist and internist who I have confirmed upfront has treated people with dermatitis herpetiformis/DH. You might have to fight like heck and call dozens or hundreds of places but at least you will not waste your time and money with doctors who are wrong and refuse to admit it all the while lengthening your suffering.

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    Guest Melissa

    Posted

    I have been suffering with severe itching for months! I saw a dermatologist and she said it was eczema. She gave me a cream which I put on my elbows and side of my butt and it seemed to help. Days later I started getting burning/itching and bumps on my neck, shoulders, low back, middle back and around to chest. They are small bumps and I do not see any blistering but they do turn to scabs after itching them. They don't itch 24/7 and seem to be worse toward evening. Does this sound like DH? They itching is severe when they do itch. I just saw my primary Dr. and she wants me to see a different Dermatologist. I am hoping this is not DH. Any input?

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    Guest christeena

    Posted

    Besides the side effects of the dapsone my problem is oral medications in general. After a long discussion with the pharmacist my suspicions were confirmed, pharmaceutical companies roll tablets in modified food starches and flour to keep them from sticking together. I am extremely allergic to gluten and cannot risk oral medications so maybe the cream would be an option. I would welcome some relief from the blisters when I get that accidental gluten poisoning.

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    Guest Carol

    Posted

    Try the Vaseline Intensive Rescue cream, together with a strictly gluten free diet when you have a flare up. All the other creams for itchy skin have oats in them...which are not gluten free. With this rash, the surface of the skin is often broken and the oats make it worse. Use only hypoallergenic soap without oats or oatmeal (Dove works great), as the skin dries out, making the itching worse.

     

    Good Luck!

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    I've been struggling with a rash for about 15 years. Saw several dermatologists and docs and was told it was an allergic reaction, shingles etc. Two years plus ago my oldest daughter was diagnosed with celiac. Trying to educate myself I finally found the answer to my rash!! During that time it would come and go to varying degrees. So, gluten-free I went. Then after a couple of month I had some gluten and then some more only to find myself covered in the rash from head to toe!! Burning and itching to the highest degree!!! I couldn't sleep, still can't. I went gluten-free once again and have followed it with the occasional glutening. Then I begin all over...I'm so tired. I'm 61 and now diagnosed with diabetes type 1 and Hypothyroidism. Started meds a month ago for both and 3 weeks in I began to break out like crazy!! So, figuring it was the diabetes meds I stopped taking them. The inflammation has subsided some, waiting on my dr to call. Now I'm wondering if it could be the iodine in my Synthroid! I've heard that Dapsone works well and I'm willing to try it, but first I need to be officially diagnosed with has come back negative since I was gluten-free for 6 months waiting for the appointment!

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    Guest Annalisa

    Posted

    I have had celiac and DH for 15 years...misdiagnosed for 10 of those years. I have been strictly gluten free for the last 5 years however earlier this year my DH came back, with a vengeance. I went to many doctors and nobody can tell me why this has come back. My best guess is stress at work which was pretty hectic for me at the beginning of the year.

     

    I found Dr Terry Wahl's on TedTalk (Minding Your Mitochondria) and she gave an excellent presentation on how she has effectively healed herself as she as MS. The idea that what we are eating can hurt and heal us intrigued me. I read her book which discusses a diet specifically for autoimmune diseases (celiac is autoimmune). I began her diet and also dove into hours and hours of research. I found another Dr with autoimmune issues and she wrote an excellent book called the Paleo Approach.

     

    After the last 8 months of DH on a gluten free diet... I changed to the "autoimmune protocol". AIP is meant to be an elimination diet that removes most allergens from our diet. once you heal you add one item in at a time and check for reactions. Ultimately you end up on a modified paleo lifestyle... Which has been amazing for me!! I sleep so much better, have tons of energy, my sporadic tummy issues are gone and most importantly my DH is completely gone. No drugs, just the right foods. Dapsone is dangerous as is destroys your healthy guy bacteria...which our damaged immune system desperately needs.

     

    If you have one autoimmune disease...you are susceptible to any other autoimmune disease (diabetes, multiple sclerosis, lupus etc)

     

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    I've been struggling with a rash for about 15 years. Saw several dermatologists and docs and was told it was an allergic reaction, shingles etc. Two years plus ago my oldest daughter was diagnosed with celiac. Trying to educate myself I finally found the answer to my rash!! During that time it would come and go to varying degrees. So, gluten-free I went. Then after a couple of month I had some gluten and then some more only to find myself covered in the rash from head to toe!! Burning and itching to the highest degree!!! I couldn't sleep, still can't. I went gluten-free once again and have followed it with the occasional glutening. Then I begin all over...I'm so tired. I'm 61 and now diagnosed with diabetes type 1 and Hypothyroidism. Started meds a month ago for both and 3 weeks in I began to break out like crazy!! So, figuring it was the diabetes meds I stopped taking them. The inflammation has subsided some, waiting on my dr to call. Now I'm wondering if it could be the iodine in my Synthroid! I've heard that Dapsone works well and I'm willing to try it, but first I need to be officially diagnosed with has come back negative since I was gluten-free for 6 months waiting for the appointment!

    FYI...Snythroid has Gluten in it! I have had this rash since August. This is the first information that I have read that makes sense. No doctor has had any answers for me. I have been gluten free for the last 2 years but I must be getting glutened somewhere. I also have corn, egg and most gluten-free grain allergies. I also believe stress activates it.

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    Hi, I just found I have DH 3 days ago, I've been having skin problems for almost year and a half. My first dermatologist told me it was ring worm, second one that it was impetigo. Third dermatologist took a couple of skin samples and the biopsy shown it was DH. I have some GI problems and I'm going on gluten free diet, but I've been reading a lot about cross reactive foods to gluten and it worries me a bit. Do you find this food harmful or do you just skip wheat, rye and barley?

    You have to avoid all of them and anything that may be made with them. Even a small amount causes a reaction in me. It is the only way I know I was glutened, since I do not have GI issues with my celiac.

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    Guest Colleen

    Posted

    I'm with you Liz. I am in despair myself. I have had it for 2 years. Completely undiagnosed. I went to 5 dermatologists, most of which insulted me. I have been called crazy with no self control. Everything, been told eczema, folliculitis, etc....I finally found someone who knew what it was but was not under my insurance and he got all "ethical" whatever THAT is and said he couldn't test me. So back to insulting dumb guy I was forced to go. I gave up. I tried again. He wouldn't test me correctly, he didn't know how. I was in despair. I had stayed on gluten for THEM the ones who dare not help me. I finally went gluten-free 2 months ago after back and forthing all of last year...emotional and painful roller coaster. I am STILL blistering in my scalp really bad and my back...I have a constant oooze on my skin...I know when they are forming...I know where they'll be....but I don't know what I am doing wrong. Things have gluten that even say they are gluten-free I guess. I can't sleep because I can't lie on either side of my head OR my back...I close my eyes for 3 hours every night in a crossed legged position sitting up...I don't hardly eat anymore because I can't take the blisters. I really feel , this is it, there is no help for me. Do i quit my job? what do i do. i cant go out in public anymore. I cant wear clothes. I cant get medicine. I cant do anything. They don't care. I am destroying my liver with Benadryl, Motrin and Excedrin and anything I can get..

     

    I get ya liz.

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    Guest Naomi

    Posted

    I have used Dapsone Cream with great success rather than taking oral Dapsone. Really worth the time to have the cream made up at a special pharmacy.

    I had a terrible reaction to oral Dapsone. Did you? Is that why you took topical dapsone? 4 Months gluten-free and I am still suffering terribly from DH.

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    Definitely good to read info from other sufferers. It's a little known or spoken about condition but has huge consequences on quality of life.

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    Iodine testing for DH: This is an old procedure used to create DH blisters. By applying a 30 percent solution of iodine as a patch, a DH outbreak can be created. This may be applicable in some patients when a biopsy is needed and no blisters are available.
    Immunofluorescence: The indirect immunofluorescence test shows that the serum of a patient contains specific antibodies that bind to different areas of the epithelium. The direct immunofluorescence tests by a skin biopsy shows a specific diagnosis pattern of DH. Traditionally this biopsy is obtained from the buttocks. If no outbreaks are observed in this area, the biopsy is recommended for another area where the itching is observed. DH Drugs: The common drugs used to initially control the blisters are: Dapsone, Sulfoxone, and Sulfapyridine. Each one has different advantages/disadvantages or availability in the treatment of DH. Dapsone changes the life span of red blood cells from an average of 120 days to 30 days. Dapsone is known for possible hematologic changes as a common side effect.

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    Gluten intolerance often presents itself in ways unexpected, including several common skin conditions.  Ranging in severity from dermatitis herpetiformis to dry skin, avoiding gluten may have more to do with your plaguing skin concerns than you imagined.
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    Dermatitits Herpetiformis—This painful, blistery condition can be very stressful, especially when misdiagnosed.  An inflamed, itchy rash, dermatitis herpetiformis begins as tiny white filled blisters or red spots around hair follicles.  Trying to hide or disguise DH, as well as trying to treat it when misdiagnosed can be incredibly stressful for a person. Eczema—Eating a gluten-free diet is becoming an increasingly popular mode of treatment for eczema.  Those who are gluten intolerant also tend to have more advanced psoriasis.Psoriasis—Like eczema, psoriasis has in many cases shown improvement when the person is put on a gluten free diet.  In Scott Adams’ 2004 article, he also mentioned that psoriasis in those with celiac tends to be more severe. Acne—Links between celiac and malabsorption, as well as hormonal upset can contribute to a greater production of acne.  Many birth control pills boast promises of clearer skin, their method is through hormone manipulation.  Because many who suffer from gluten intolerance also experience a disruption of normal hormone function, this disharmony can lead to problems with acne.  Dry Skin—Also correlated to malabsorption, dry skin is a very common complaint amongst those with celiac.  But this condition is one that many people see even after the prescribed treatment of a gluten free diet.  Why?  Vitamin E rich grains are vital to maintaining skin harmony, but since many who are gluten intolerant begin avoiding grains completely—even those grains that are gluten-free, getting that important Vitamin E in their diets can become a challenge.


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    Serve is a bowl with tortilla chips and guacamole.

    Dr. Ron Hoggan, Ed.D.
    Celiac.com 06/15/2018 - There seems to be widespread agreement in the published medical research reports that stuttering is driven by abnormalities in the brain. Sometimes these are the result of brain injuries resulting from a stroke. Other types of brain injuries can also result in stuttering. Patients with Parkinson’s disease who were treated with stimulation of the subthalamic nucleus, an area of the brain that regulates some motor functions, experienced a return or worsening of stuttering that improved when the stimulation was turned off (1). Similarly, stroke has also been reported in association with acquired stuttering (2). While there are some reports of psychological mechanisms underlying stuttering, a majority of reports seem to favor altered brain morphology and/or function as the root of stuttering (3). Reports of structural differences between the brain hemispheres that are absent in those who do not stutter are also common (4). About 5% of children stutter, beginning sometime around age 3, during the phase of speech acquisition. However, about 75% of these cases resolve without intervention, before reaching their teens (5). Some cases of aphasia, a loss of speech production or understanding, have been reported in association with damage or changes to one or more of the language centers of the brain (6). Stuttering may sometimes arise from changes or damage to these same language centers (7). Thus, many stutterers have abnormalities in the same regions of the brain similar to those seen in aphasia.
    So how, you may ask, is all this related to gluten? As a starting point, one report from the medical literature identifies a patient who developed aphasia after admission for severe diarrhea. By the time celiac disease was diagnosed, he had completely lost his faculty of speech. However, his speech and normal bowel function gradually returned after beginning a gluten free diet (8). This finding was so controversial at the time of publication (1988) that the authors chose to remain anonymous. Nonetheless, it is a valuable clue that suggests gluten as a factor in compromised speech production. At about the same time (late 1980’s) reports of connections between untreated celiac disease and seizures/epilepsy were emerging in the medical literature (9).
    With the advent of the Internet a whole new field of anecdotal information was emerging, connecting a variety of neurological symptoms to celiac disease. While many medical practitioners and researchers were casting aspersions on these assertions, a select few chose to explore such claims using scientific research designs and methods. While connections between stuttering and gluten consumption seem to have been overlooked by the medical research community, there is a rich literature on the Internet that cries out for more structured investigation of this connection. Conversely, perhaps a publication bias of the peer review process excludes work that explores this connection.
    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics