Geographic Tongue (Glossitis) and its Relationship with Celiac Disease

Celiac.com 01/27/2011 - In response to a post on the celiac listserv stating that both a pediatrician and a dermatologist dismissed the possibility of a connection between previously diagnosed celiac disease and geographic tongue, I wrote the following:

One of several early mentions of geographic tongue (glossitis) in association with celiac disease may be found in the medical textbook "Coeliac Disease" by Cooke and Holmes, Churchill Livingstone, 1984, on pages 84 and 85 under the heading "glossitis". They say that it occurs, to a greater or lesser extent, "in a majority of celiac patients" (1). 

Celiac.com Sponsor (A12):
Another very informative article on glossitis can be found at:
http://www.nejm.org/doi/full/10.1056/NEJMc070200

In this recent article from the New England Journal of Medicine (2007)  the authors also state that the connection between celiac disease and glossitis is very common. They go on to say: "Our report should alert physicians and dental practitioners to consider celiac disease in managing cases of idiopathic atrophic glossitis." In other words, they want physicians and dentists to be aware that there may be underlying celiac disease when they encounter glossitis. This information is neither controversial nor difficult to locate. Celiac disease is not the only cause of glossitis, or geographic tongue, but it is a common and long acknowledged symptom of celiac disease, with mention of this connection in the medical literature at least as early as 1974.  
   
My own experience with glossitis is that most of my problems went away when I began a gluten-free diet. The remainder of my glossitis resolved after getting IgG food allergy testing from Immuno Labs in Ft. Lauderdale, and removing all identified allergenic foods from my diet. (I have since re-introduced some of these foods but I avoided them for about 5 years. ( 12 years later, I still have to avoid some of the foods identified by that testing.)

My questions/concerns are:

1. Is your daughter eating gluten? Is it possible that there is gluten contamination in her diet?
2. Is she eating oats? A significant portion of celiac patients do react to oats, yet oat consumption is now widely advocated. 
3. Has she had testing for common food allergies? If she is strictly gluten-free and avoiding oats, then food allergy testing may provide her with the the information she needs to eliminate this source of her discomfort.  

I am distressed that neither the pediatrician nor the dermatologist took just a few minutes to run a Medline search that would have informed them about the connection between celiac disease and glossitis and some possible treatments for her problem.  Accidental or intentional gluten consumption, oats consumption, and food allergy testing are all relatively easy for either of these physicians to address. There may, of course, be some other explanation for your daughter's affliction, but these physicians' ignorance of the connection with celiac disease and their failure to run a quick Medline search does not inspire confidence in their opinions.  You might want to pursue a third opinion on this issue, especially since the topical drug she was prescribed falls well short of solving such autoimmune/allergic problems, which almost assuredly is the underlying cause of your daughter's difficulties with her tongue.

Sources:

1. Cooke WT, Holmes GKT. Coeliac Disease. Churchill Livingstone, NY, 1984
2. Pastore L &  Lo Muzio L. Atrophic Glossitis Leading to the Diagnosis of Celiac DiseaseN Engl J Med 2007; 356:2547June 14, 2007
3. Lampert F, Harms K, Bidlingmaier F, Kiefhaber P, Meister P.Pernicious anemia with dermatologic and neurologic involvement in a 10-year-old boy. Monatsschr Kinderheilkd. 1974 May;122(5):217-20.
4. Barry RE, Baker P, Read AE.Coeliac disease. The clinical presentation. Clin Gastroenterol. 1974 Jan;3(1):55-69