Search the Community

Celiac.com 06/12/2023 - Celiac disease is an autoimmune disorder characterized by gastrointestinal symptoms and nutrient deficiencies. While genetic factors, particularly HLA association, play a significant role in its development, the exact environmental triggers remain unclear. Recent studies have proposed infections as potential contributing factors. With the Covid-19 pandemic causing a systemic inflammatory response and affecting the gastrointestinal tract, researchers in southern Sweden set out to investigate whether Covid-19 infection could increase the risk of developing celiac disease. The research team included Jesper Lexner, Ylva Lindroth and Klas Sjöberg. They are variously affiliated with the Department of Gastroenterology and Nutrition, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden; and the Division of Medical Microbiology, Department of Laboratory Medicine, Skåne University Hospital, Lund University, Lund, Sweden. The Covid-19 and Celiac Disease Connection To explore the potential association between Covid-19 infection and celiac disease, the researchers identified all patients, including children and adults, in the county of Skåne with newly diagnosed biopsy- or serology-verified celiac disease or positive tissue transglutaminase antibody tests (tTG-ab) from 2016 to 2021. They also identified individuals who tested positive for Covid-19 using PCR or antigen tests in 2020 and 2021. The Findings During the period from March 2020 to December 2021, there were 201,050 cases of Covid-19 in Skåne, and among them, 568 patients were diagnosed with celiac disease or had positive tTG-ab tests. Interestingly, only 35 of these patients had previously been infected with Covid-19. Contrary to initial expectations, the incidence of verified celiac disease and tTG-ab positivity was lower during the Covid-19 pandemic compared to before. The incidence rates of celiac disease were 21.1 and 22.4 cases per 100,000 person-years for patients with and without prior Covid-19 infection, respectively. Implications of the Study The findings of this study suggest that Covid-19 infection is not a significant risk factor for the development of celiac disease. While previous research has indicated that gastrointestinal infections may play a role in the pathogenesis of celiac disease, respiratory infections, such as those caused by the SARS-CoV-2 virus, appear to have less relevance in this regard. Study Limitations It is important to note that this study focused on a specific region in southern Sweden and the findings may not be generalizable to other populations or geographic areas. Further research involving larger and more diverse populations is warranted to validate these findings. Additionally, the study did not explore potential mechanisms underlying the connection between gastrointestinal infections and celiac disease pathogenesis, highlighting the need for future investigations in this area. Understanding the environmental triggers and risk factors associated with celiac disease is crucial for improving diagnosis, treatment, and prevention strategies. While the Covid-19 pandemic has posed significant challenges worldwide, this study suggests that Covid-19 infection does not increase the risk of developing celiac disease. Read more in BMC Gastroenterology volume 23, Article number: 174 (2023)

Celiac.com 03/20/2023 - People with celiac disease who contract COVID-19 are twice as likely to be hospitalized as non-celiacs, according to a new U.S. study, published online in Clinical Gastroenterology and Hepatology. However, the study also found that COVID-19 vaccination decreased the risk of hospitalization by nearly 50% for both groups. This is the first study to show the effect of vaccination on reducing the risk of hospitalization in patients with celiac disease and COVID-19 infection. Despite the increased risk of hospitalization, patients with celiac disease did not experience significant differences in intensive care unit requirement, mortality, or thrombosis compared to non-celiacs. The study suggests that celiac disease patients with COVID-19 are not inherently at greater risk for severe outcomes. The researchers compared COVID-19 incidence and outcomes between patients with and without celiac disease before and after vaccination and found similar outcomes between the two groups before vaccination. The study analyzed 171,763 patients diagnosed and treated for COVID-19 at the institution between March 1, 2020, and January 1, 2022, with 110 of those adults having biopsy-proven celiac disease. The median time from biopsy diagnosis of celiac disease to COVID-19 was 217 months, with more than 2 out of 3 patients following a gluten-free diet. Read more at Medscape Medical News

Celiac.com 05/12/2022 - Recent studies suggest that KIR+CD8+ T cells could offer a path to controlling autoimmune diseases, such as “long COVID,” which emerge after viral infections. Ly49+CD8+ T cells are a subset of CD8+ T cells that have shown immunoregulatory activity in mice. These cells can suppress myelin oligodendrocyte glycoprotein (MOG)–specific pathogenic CD4+ T cells through their cytolytic activity and thereby ameliorate experimental autoimmune encephalomyelitis (EAE). However, whether a similar CD8+ regulatory T cell subset exists in humans and whether its suppressive activity extends beyond autoimmune diseases to play a more general role in peripheral tolerance remains to be determined. A team of researchers recently shared some relevant findings regarding CD8+ T cells in humans. The research team included Jing Li; Maxim Zaslavsky; Yapeng Su; Jing Guo; Michael J Sikora; Vincent van Unen; Asbjørn Christophersen; Shin-Heng Chiou; Liang Chen; Jiefu Li; Xuhuai Ji; Julie Wilhelmy; Alana M McSween; Brad A Palanski; Venkata Vamsee Aditya Mallajosyula; Nathan A Bracey; Gopal Krishna R Dhondalay; Kartik Bhamidipati; Joy Pai; Lucas B Kipp; Jeffrey E Dunn; Stephen L Hauser; Jorge R Oksenberg; Ansuman T Satpathy; William H Robinson; Cornelia L Dekker; Lars M Steinmetz; Chaitan Khosla; Paul J Utz; Ludvig M Sollid; Yueh-Hsiu Chien; James R Heath; Nielsen Q Fernandez-Becker; Kari C Nadeau; Naresha Saligrama; and Mark M Davis. A recent report by Li et al., notes the existence of a similar CD8+ T cell subset in humans, which possess killer cell immunoglobulin-like receptors (KIRs). This function in humans mirrors that in the mouse Ly49 family. These cells are able to suppress self-reactive CD4+ T cells, and are more plentiful in patients with autoimmune conditions, such as celiac disease, multiple sclerosis, and lupus, as well as in patients infected with influenza virus or severe acute respiratory syndrome coronavirus 2. When researchers injected viruses into mice selectively deficient in Ly49+CD8+ T cells, the mice showed normal antiviral immune responses, but they later developed symptoms of autoimmune disease. The team found that CD8+ T cells express inhibitory killer cell immunoglobulin-like receptors (KIRs), making them the human equivalent of Ly49+CD8+ regulatory T cells in mice. These CD8+ T cells are abundant in the blood and inflamed tissues of patients with several different autoimmune diseases. Moreover, these CD8+ T cells easily eliminated pathogenic gliadin-specific CD4+ T cells from the leukocytes of celiac disease patients in vitro. Because of this, KIR+CD8+ T cells could offer a path to controlling autoimmune diseases, such as “long COVID,” which emerge after viral infections. Tellingly, in COVID-19 patients, the team also found elevated levels of KIR+CD8+ T cells, but not CD4+ regulatory T cells, which corresponded to disease severity, and levels of vasculitis. Selective destruction of Ly49+CD8+ T cells in virus-infected mice reversed their infections, and restored their autoimmunity. These results suggest that in humans, as in mice, these regulatory CD8+ T cells act uniquely to suppress pathogenic T cells in autoimmune and infectious diseases. Read more in Science. 2022 Apr 15;376(6590):eabi9591. Also: PubMed. The researchers are variously affiliated with the Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA; the Program in Computer Science, Stanford University, Stanford, CA, USA; the Institute for Systems Biology, Seattle, WA, USA; the Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA; the Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA; the KG Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway; the Institute of Clinical Medicine, University of Oslo, Oslo, Norway; the Department of Immunology, University of Oslo, Oslo, Norway; The Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA; the Human Immune Monitoring Center, Stanford University School of Medicine, Stanford, CA, USA; the Department of Chemistry, Stanford University, Stanford, CA, USA; Sean N; Parker Center for Allergy and Asthma Research, Department of Medicine, Stanford University, Stanford, CA, USA; the Program in Immunology, Stanford University School of Medicine, Stanford, CA, USA; Division of Neuroimmunology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; the Department of Neurology and UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; VA Palo Alto Health Care System, Palo Alto, CA, USA; the Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA; the Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA; the Stanford Genome Technology Center, Stanford University, Palo Alto, CA, USA; the European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany; the Department of Chemical Engineering, Stanford University, Stanford, CA, USA; the Stanford ChEM-H, Stanford University, Stanford, CA, USA; the Department of Immunology, Oslo University Hospital, Oslo, Norway; the Department of Bioengineering, University of Washington, Seattle, WA, USA; and the Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, CA, USA.

Celiac.com 04/18/2022 - Several observational studies have indicated that celiac disease patients do not have higher susceptibility of COVID-19 and the risk of severe COVID-19. However, the the conclusions of such studies can be distorted by reverse causation and confounding, especially for newly-emerged diseases, such as COVID-19. A team of researchers recently set out to further clarify the picture using both observational and Mendelian Randomization analysis. The research team included Jiuling Li, Aowen Tian, Dandan Yang, Miaoran Zhang, Lanlan Chen, Jianping Wen, and Peng Chen. For their observational study, the team used data from the UK Biobank cohort. They conducted both univariate and multivariate logistic regression analysis to identify the risk factors for both COVID-19 susceptibility and severe COVID-19. They also conducted a two-sample Mendelian Randomization analysis to delineate causality between celiac disease and COVID-19 susceptibility and severe COVID-19. The good news is that the team's UK Biobank data revealed that celiac disease patients had a slightly lower overall susceptibility to COVID-19, and that celiac patients did not have higher rates of severe COVID-19. Meanwhile, the Mendelian Randomization study showed that celiac patients had lower susceptibility to both COVID-19 and fewer cases of severe COVID-19, although the lower COVID-19 susceptibility is seen in only in the UK Biobank cohort. These results indicate that people with celiac disease do not face higher risk of getting COVID-19, or of developing severe COVID, than the non-celiac population, and they likely do not need to take any extra COVID-19 precautions. Read more in Clin Transl Gastroenterology The researchers in this study are variously affiliated with the Department of Pathology, College of Basic Medical Sciences, Jilin University in Changchun, Jilin, China; the Experimental Center of Pathogenobiology, Immunology, Cytobiology and Genetics, College of Basic Medical Sciences, Jilin University in Changchun, Jilin, China; the Clinical Medicine of Jilin University in Changchun, Jilin, China; and the Department of Genetics, College of Basic Medical Sciences, Jilin University in Changchun, Jilin, China.

Celiac.com 02/14/2022 - Prior studies have found links between the gut microbiome and COVID-19, along with other diseases. However, a new study by investigators at the Chinese University of Hong Kong offers the first published data specifically linking gut health to COVID's long-term effects. The research team assessed 106 patients with COVID-19 from February to August 2020, at three different hospitals, and compared their results against a group of patients recruited in 2019, who did not have COVID. Patients had mostly mild to moderate Covid severity. At 3 months, nearly ninety of the COVID patients had post–acute COVID-19 syndrome (PACS), which researchers defined as at least one persistent, otherwise unexplained symptom 4 weeks after testing negative for Covid. After six months, more than eighty patients still had PACS, with the main complaints being anxiety, fatigue, poor memory, hair loss, and difficulty sleeping. Stool sample analysis of PACS patients showed sharply lower bacteria diversity and abundance at six months, compared with with control subjects, and those without PACS. In patients with PACS, at both baseline and follow-up, nearly thirty bacteria species were reduced, while nearly fifteen were increased. Patients with COVID but not PACS showed just 25 changes to bacteria species at hospital intake, and all of those patients normalized by 6 months. The team linked patient respiratory symptoms at 6 months to higher levels of opportunistic pathogens such as Streptococcus anginosus and S. vestibularis. They also tied neuropsychiatric symptoms and fatigue to nosocomial pathogens, which are linked to opportunistic infections, such as Clostridium innocuum and Actinomyces naeslundii (P < .05). Bacteria that produce the beneficial fatty acid butyrate were substantially reduced in patients with hair loss. They also found that specific bacteria, including Bifidobacterium pseudocatenulatum and Faecalibacterium prausnitzii, showed the greatest inverse correlations with PACS at 6 months.. "Particular gut microbial profiles may indicate heightened susceptibility," said Dr Siew Ng, MBBS, PhD, associate director at the university's Center for Gut Microbiota Research. "Although the findings were drawn from patients with earlier strains of the COVID-19 virus, the findings still apply to new variants, including Omicron, since these pose the same problem of persistent disruption of the immune system," Ng adds. Dr Ng's group is currently carrying out trials to assess how long COVID might be prevented, and antibodies boosted, by modulating the microbiome after vaccination in high-risk people. "To our knowledge, this is the first study to show that altered gut microbiome composition is strongly associated with persistent symptoms in patients with COVID-19 up to 6 months after clearance of SARS-CoV-2 virus," said Dr Ng. Meanwhile, Eugene Chang, MD, professor of medicine at the University of Chicago, who has studied the gut microbiome and gastrointestinal disease, cautions that the study is "too preliminary" to lead to any clinical changes. Dr. Chang notes that the observations merely identify the microbes present, not their actual effects. Stay tuned for more on this and related stories about celiac disease and Covid. Read more in Medscape Medical News

Celiac.com 02/01/2022 - As the drama over unvaccinated world number one tennis star, Novak Djokovic, continues to unfold, his recent experiences in Australian quarantine are coming into focus. For a bit of perspective, in an effort to gain entry into the Australian Open tennis tournament, Djokovic recently attempted to enter Australia without proof of vaccine, in violation of Australian immigration law. For his troubles, he was sent to quarantine, pending appeal. When he lost his appeal, he was quickly booted out of the country, and now faces a three year ban on re-entry. In the process, he was unable to play in the Australian Open tennis championships, where he was heavily favored to win. Questions of Special Treatment Numerous people have accused the Australia government of providing special treatment for Djokovic. Regular people in quarantine, people like you and me, rarely get special privileges. Many in quarantine, even people with celiac disease, can face deprivation and long waits to get the get gluten-free food they require. For non-celebrities in quarantine, conditions at the Park Hotel are not nearly as plush. Just one floor above Djokovic, many of the 30 asylum seekers have been detained more than two years, despite not being charged with any crimes. As one such detainee, Hossein Latifi told reporters: "We are stuck in our room. There is no fresh air. We don't have any place for training. There is no gym here. It's very hard...We are refugees, we are innocent people - we've not committed any crime. They just keep me like hostage here." Even before Djokovic's arrival, detainees made allegations that food contained maggots and bread was routinely moldy. So, it must be nice to not only get gluten-free meal deliveries, but also exercise equipment and a sim-card and computer, as Djokovic recently received during his stay in Australian quarantine. For his part, Djokovic had plenty of outside help, during his stay in quarantine. According to the Serbian prime minister's office, Serbian officials were "trying everything to make the situation easier for Djokovic." Meanwhile, questions arose about what seemed to many like special treatment for Djokovic, especially compared to the treatment seen by most non-celebrities in quarantine. The newspaper, The Australian previously reported, with a seemingly straight face, that the tennis star had been denied any "special treatment." To be fair, Australian immigration officials did turn down Djokovic's requests for access to his personal chef and a tennis court, according to reports. So maybe that's what they meant by receiving "no special treatment." Certainly, anyone with celiac disease, or any medical condition, facing quarantine, should receive the treatment they require, including gluten-free food. The issue here is that for many non-celebrities, such services and treatments are often not readily available. At the end of the day, the issue seems to be one of fairness. Regardless of their wealth or celebrity, everyone deserves the same, decent treatment in detention. If Djokovic can get gluten-free food, exercise equipment and computer access, why can't everyone else in the same situation? The easiest, and perhaps unsurprising answer is that there are two standards at work: one for rich celebrities, and one for everyone else. Under current regulations, Djokovic faces bans on entry to the French Open and the U.S. Open tennis championships--with French authorities barring all non-Covid-vaccinated people, including athletes, from public sporting events, and U.S. immigration rules requiring all non-citizens to provide proof of Covid vaccination to enter the country. Should Djokovic and his team decide to try their luck again by showing up to either of these countries without getting vaccinated, we may get to see another test of privilege versus rules. Stay tuned for more on this and related stories. Rad more in SkyNews

Celiac.com 12/27/2021 - To better understand the rates of hospitalization, mortality, thrombosis or intensive care unit (ICU) treatment in individuals with celiac disease and COVID-19, a team of researchers recently set out to assess the clinical characteristics, hospitalization and mortality rates of COVID-19 among U.S. celiac disease patients. The research team included Emad Mansoor, Muhammed Mustafa Alikhan, Jaime Abraham Perez, Kayla Schlick, Mohannad Abou Saleh, and Dr Alberto Rubio-Tapia. They are variously affiliated with the Department of Medicine; Digestive Health Institute, University Hospitals of Cleveland, Cleveland, Ohio, USA; the Department of Medicine, University Hospitals of Cleveland, Cleveland, Ohio, USA; the Center for Clinical Research, Case Western Reserve University, Cleveland, Ohio, USA, Department of Medicine; the Division of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA. The team notes that their work was sparked, in part, by Belli et al1 regarding outcomes of COVID-19 in liver transplant candidates. The authors in Belli et al concluded that liver transplant candidates were at risk of early death, especially those with decompensated cirrhosis and model for end-stage liver disease score of 15 or above. That research team reviewed clinical outcomes in celiac patients after a diagnosis of COVID-19. Although the evidence of COVID-19's impact of other chronic disorders is emerging, researchers still don't know very much about the consequences of COVID-19 infection in people with celiac disease. To compile the celiac disease cohort, the team used the TriNetX healthcare research network to compile the electronic medical records of adults with celiac disease, and confirmed COVID-19 infection, from 51 healthcare organizations in the USA, between 1 January 2020 and 7 July 2021. For the non-celiac disease cohort, they also identified COVID-19 positive patients, with no history of celiac disease, from the same time period. They defined celiac disease by the International Classification of Disease, 10th Revision (celiac disease-10) diagnostic code and related codes, such as villous atrophy present on biopsy of small intestine and positive autoantibody screening. For both groups, the team studied the risk of hospitalization, mortality, thrombosis, and ICU requirement within 90 days of COVID-19 diagnosis. They also performed 1:1 propensity score matching using a greedy nearest-neighbor matching algorithm to account for potential confounding variables. Overall, the researchers found no significant differences among any of the measured outcomes in those with celiac disease, compared with non-celiac patients with COVID-19, after propensity score matching. Understanding more about COVID-19 outcomes of patients with celiac disease will researchers and patients to get a better idea of any potential concerns or options, and potentially lead to better outcomes. Read the full findings in Gut. Reference: Belli LS, Duvoux C, Cortesi PA, et al. COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study. Gut 2021;70:10.1136/gutjnl-2021-324879:1914–24. doi:10.1136/gutjnl-2021-324879

Celiac.com 12/20/2021 - Janet and Maku Game of Edmonton, Canada arrived in Toronto early on Dec. 4. Because Maku had traveled to South Africa within the 14 day window set by Canadian authorities, the pair were ordered to quarantine until they received a negative COVID-19. They ended up stuck in a quarantine nightmare with no gluten-free food for Janet for nearly two days. Concerns about the rapidly spreading Omicron variant, have led Canadian authorities to require that anyone who has traveled to South Africa within 14 days remain in quarantine until they receive a negative COVID-19 test, even those who are already vaccinated. According to recent reports, Maku has had three doses of the COVID-19 vaccine and Janet has had two doses. Janet said she has severe celiac disease and her food must be 100% gluten-free or she will suffer great pain and diarrhea. Maku said they told the Hilton hotel about the dietary restriction when they first arrived. The pair had eaten before arriving at the hotel for quarantine, but they received no dinner that night, and no meal the next morning, Dec. 5th. Lunch, their first meal, was a dish of rice and vegetables, and a single portion of crispy chicken that was not gluten-free. They couple reported that Red Cross Canada is only one point of contact at the hotel, but that no one was on staff at reception. They wanted to get some proper food, as Janet was nursing a broken leg she injured in Africa, and drinking sugary drinks to keep her energy up. They tried calling Red Cross at least five times throughout Dec. 5 and said they were on hold for up to an hour before getting in touch with someone. Around 9:40 p.m. that night, Janet received a banana and apple, followed by a gluten-free bagel the next morning a little before 9 a.m. on the 6th. By that time, she had gone 41 hours without a proper meal. “I just want to go home,” Janet told reporters for Global News. “I’m extremely tired and extremely exhausted.” Under the quarantine rules, the Games were not allowed to leave their room or receive any food orders, such as from Uber Eats or from their relatives who live nearby. “It’s so scary,” Janet said of the hotel atmosphere. “You can’t see anybody. They put wall-to-wall plastic...It’s like a science-fiction world here.” After receiving a negative COVID-19 test result after pushing the lab to expedite their results, they were still waiting for public health to give them the go-ahead as of Monday at noon to be able to board a flight back to Edmonton, where they have lived for 20 years. Being stuck in a situation where you cannot order or received food, and can only get what you're given by those in charge, and trying not to starve as they fumble in trying to get you something gluten-free is a true nightmare for most people with celiac disease. Read more at GlobalNews.ca

Celiac.com 10/04/2021 - How symptoms and antibodies related to SARS-CoV-2 infection develop in patients with celiac disease is unclear. Is it similar to non-celiacs? A team of researchers recently set out to investigate the impact of SARS-CoV-2 infection in celiac patients. The team asked celiac disease patients about how their COVID-19 symptoms developed, how they were complying with anti-virus measures and, how strictly they were following a gluten-free diet. The team compared data on the rates of anti-SARS-CoV-2 IgG and IgA (anti-RBD and N proteins) in celiacs with data for non-celiacs. They also looked at expression of the duodenal ACE2 receptor. Where possible, they analyzed data on duodenal histology, anti-tissue transglutaminase IgA (tTGA), comorbidities and GFD adherence. The team looked at a total of 362 celiac patients, 42 of which reported COVID-19 symptoms (12%), with 21% of these symptomatic patients testing positive for anti-SARS-CoV-2 Ig. Overall, 18% of celiac patients showed anti-SARS-CoV-2 Ig compared with 25% of the control group. Celiac patients had significantly lower levels of anti-N IgA. Symptoms and/or antibodies were not affected by tTGA, duodenal atrophy, gluten-free diet adherence, or other comorbidities. They did detect ACE2 receptor in the non-atrophic duodenal mucosa of patients; which, is associated with atrophy at lower levels. Except for anti-N IgA, celiac disease patients have an anti-SARS-CoV-2 Ig profile similar to non-celiacs. The team found no risk factors tied to celiac disease parameters or gluten-free diet adherence. Read more in Digestive and Liver Disease The research team included Luca Elli; Federica Facciotti; Vincenza Lombardo; Alice Scricciolo; David S. Sanders; Valentina Vaira; Donatella Barisani; Maurizio Vecchi; Andrea Costantino; Lucia Scaramella; Bernardo dell'Osso; Luisa Doneda; and Leda Roncoroni. They are variously affiliated with the Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; the European Institute of Oncology IRCCS; the Centre for Prevention and Diagnosis of Celiac Disease; the Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; the Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom; the School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; the Pathology Unit, and the Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; and the Centre for Prevention and Diagnosis of Celiac Disease.

Celiac.com 06/28/2021 - There is a growing body of data to suggest the intestinal action of SARS-CoV-2, with ciliated cells and intestinal enterocytes serving as target cells, due to high expression of ACE2 and TMPRSS2, could possibly trigger celiac disease in predisposed individuals. Indeed, COVID-19 promotes a “cytokine storm” in the intestinal mucosa, triggering epithelial damage that increases barrier permeability, permitting gliadin to "leak" into the intestinal lamina. However, the possible impact of the SARS-CoV-2 infection, and the resulting disease, on celiac disease rates remains unknown, with no data currently available on the development of systemic disorder, or on long-term outcomes. A team of researchers recently set out to highlight the potential risk of a rise in celiac disease rates among genetically predisposed subjects following SARS-CoV-2 infection, based on several factors which could promote the development of celiac disease. The research team included Chiara Maria Trovato, Monica Montuori, Nicoletta Pietropaoli, and Salvatore Oliva. They are variously affiliated with the Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy; and the Hepatology Gastroenterology and Nutrition Unit, "Bambino Gesù" Children Hospital, Rome, Italy. The team used current medical literature to help them hypothesize the role of COVID-19 as a possible trigger for celiac disease development in predisposed individuals. They suggest that genetically predisposed people could be more likely to develop celiac disease following SARS-CoV-2 infection, making COVID-19 a potential driver of increased celiac disease cases in the future. An unexpected rise in celiac cases among genetically predisposed individuals in the wake of the COVID-19 pandemic would support the team's hypothesis. Time will tell if they are right. Stay tuned for more stories regarding COVID-19, celiac disease, and related topics. Read more in the International Journal of Clinical Practice

Celiac.com 06/16/2021 - Weeks after SARS-CoV-2 infection or exposure, some children develop a severe, life-threatening illness called Multisystem Inflammatory Syndrome in Children (MIS-C). A new study offers hope for diagnosis, treatment and prevention of MIS-C. Gastrointestinal symptoms are common in MIS-C patients and severe hyperinflammatory response ensues with potential for cardiac complications. The cause of MIS-C has not previously been identified. A team of researchers recently set out to learn more about diagnosing, treating, and preventing MIS-C. The research team analyzed specimens from 19 children with MIS-C, 26 with acute COVID-19, and 55 control subjects and assessed stool samples for SARS-CoV-2 by RT-PCR, and plasma samples for markers of breakdown of mucosal barrier integrity, including zonulin. They used ultra-sensitive antigen detection to probe for SARS-CoV-2 antigenemia in plasma, and then characterized the resulting immune responses. As proof of concept, we treated a MIS-C patient with larazotide, a zonulin antagonist, and monitored impact on antigenemia and clinical response. The team demonstrated that, in MIS-C patients, prolonged presence of SARS-CoV-2 in the GI tract leads to the release of zonulin, an intestinal permeability biomarker, which causes SARS-CoV-2 antigens to flow into the bloodstream, and triggers hyperinflammation. The one MIS-C patient treated with larazotide, a drug which is currently in clinical trials as a possible treatment for celiac disease, showed a coinciding decrease in plasma SARS-CoV-2 Spike antigen levels, inflammatory markers, along with clinical improvement above that resulted from presently available treatments. The team's data detailing the pathogenesis of MIS-C offers insight into targets for diagnosing, treating, and preventing MIS-C, which are crucial to addressing this increasingly common severe COVID-19-related disease in children. Read more at The Journal of Clinical Investigation. The research team included Lael M. Yonker, Tal Gilboa, Alana F. Ogata, Yasmeen Senussi, Roey Lazarovits, Brittany P. Boribong, Yannic C. Bartsch, Maggie Loiselle, Magali Noval Rivas,4 Rebecca A. Porritt,4 Rosiane Lima,1 Jameson P. Davis, Eva J. Farkas, Madeleine D. Burns, Nicola Young, Vinay S. Mahajan, Soroush Hajizadeh, Xcanda I. Herrera Lopez,5 Johannes Kreuzer, Robert Morris, Enid E. Martinez, Isaac Han, Kettner Griswold Jr., Nicholas C. Barry, David B. Thompson, George Church, Andrea G. Edlow, Wilhelm Haas, Shiv Pillai, Moshe Arditi, Galit Alter, David R. Walt, and Alessio Fasano. They are variously affiliated with the Department of Pediatrics, Massachusetts General Hospital, Boston, United States of America; the Department of Pathology, Brigham and Women’s Hospital, Boston, United States of America; the Department of Medicine, Ragon Institute of MGH, MIT and Harvard, Cambridge, United States of America; the Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, United States of America; the Department of Medicine, Massachusetts General Hospital, Boston, United States of America; the Department of Immunology, Wyss Institute for Biologically Inspired Engineering, Boston, United States of America; the Department of Genetics, Harvard Medical School, Boston, United States of America; the Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, United States of America; the Massachusetts General Hospital, Boston, United States of America; the Department of Immunology, Massachusetts General Hospital, Boston, United States of America; and the Department of Pathology, Harvard Medical School, Boston, United States of America.

Celiac.com 05/10/2021 - A top physician in Turkey recently warned that rates of autoimmune diseases like Type 1 diabetes and celiac will likely rise in the wake of the coronavirus pandemic. Autoimmune diseases, including thyroid issues, happen when the body attacks its own tissues. The coronavirus causes the body's immune system to produce “attacking” antibodies. Because "[v]iruses serve as a mechanism that pull the trigger for autoimmune diseases,” an increase in rates of autoimmune diseases was unavoidable after a year of pandemic," says Professor Tufan Tükek, head of the Faculty of Medicine at Istanbul University. Lingering COVID-19 symptoms Impede Autoimmune Disease Management Ongoing coronavirus symptoms have been a problem for numerous recovered patients, and can impair the management of autoimmune diseases. For example, in diabetes patients, studies show that the symptoms influence blood sugar levels, and impede its management by causing fatigue and memory issues. In March 2020, Istanbul University became one of the first institutions in the country to establish an observation center for recovered coronavirus patients. Since then, they have monitored nearly 4,000 patients. Professor Tükek says that, in the early days of the pandemic, diarrhea was the main "long COVID-19" symptom, and then, after a second COVID-19 wave last summer, their team began seeing more memory issues and hair loss. Lately, Tükek said, they are seeing more cases of blood clots. COVID-19 Symptoms Can Linger for Months Dr. Huzeyfe Arıcı, a physician working at the observation center, said that COVID-19 symptoms can linger for up to eight weeks, in many cases. “We have patients suffering from back pain that long, something that cannot be cured by painkillers. We also see an increasing number of cases with memory lapses,” he stressed. With COVID-19 survivors numbering in the millions, it is an open question as to how many will be affected by lingering symptoms, for how long, and what can be done to help them. The idea that coronavirus could increase rates of diabetes, celiac or other autoimmune conditions is bit alarming. Quantifying and describing the problems and then creating a way to address them is crucial. Look for more information as other observation centers share their observations on COVID-19 survivors. Read more in Dailysabah.com

Celiac.com 03/15/2021 - COVID-19 is mainly a respiratory illness, but there is mounting evidence to indicate that the gut and gut microbiota may play a role in the disease. A team of researchers recently set out to determine if the gut microbiome is linked to disease severity in patients with COVID-19, and whether variations in microbiome composition might resolve with the passing of the SARS-CoV-2 virus. The research team included Yun Kit Yeoh, Tao Zuo; Grace Chung-Yan Lui; Fen Zhang; Qin Liu; Amy YL Li; Arthur CK Chung; Chun Pan Cheung; Eugene YK Tso; Kitty SC Fung; Veronica Chan; Lowell Ling; Gavin Joynt; David Shu-Cheong Hui; Kai Ming Chow; Susanna So Shan Ng; Timothy Chun-Man Li; Rita WY Ng; Terry CF Yip; Grace Lai-Hung Wong; Francis KL Chan; Chun Kwok Wong; Paul KS Chan; and Siew C Ng. To get the answers, the team reviewed blood, stool and patient records from 100 patients with laboratory-confirmed SARS-CoV-2 infection, from two different hospitals. They collected serial stool samples from 27 of the 100 patients up to 30 days after the resolution of SARS-CoV-2. They assessed gut microbiome composition by shotgun sequencing total DNA from stool extraction. They then measured plasma concentrations of inflammatory cytokines and blood markers. Compared with non-COVID-19 patients, those with COVID-19 showed a substantially changed gut microbiome, whether or not they received medication. In COVID-19 patients, a number of gut microbiota with known immunomodulatory potential, such as Faecalibacterium prausnitzii, Eubacterium rectale and bifidobacteria were low, and remained low up to 30 days after Covid-19 abated. In these cases, Covid-19 severity reflected elevated concentrations of inflammatory cytokines and blood markers such as C reactive protein, lactate dehydrogenase, aspartate aminotransferase and gamma-glutamyl transferase. The connections between gut microbiota composition, levels of cytokines and inflammatory markers in patients with COVID-19 suggest that gut microbiota composition reflects disease severity and weakened immune responses. Moreover, because gut microbiota imbalance after Covid-19 resolution may lead to persistent symptoms, it is important to understand how gut microorganisms are involved in inflammation and COVID-19. Read more in Gut The researchers are variously affiliated with the Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong; the Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; the Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong; the State Key Laboratory for digestive disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong; the Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong; the Department of Pathology, United Christian Hospital, Kwun Tong, Hong Kong; the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong; the Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong; the Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.

Celiac.com 03/01/2021 - Although COVID-19 mainly affects the respiratory system, growing evidence indicates that the GI tract also plays a role in the disease. A team of researchers recently set out to determine if the gut microbiome is connected to disease severity in patients with Covid-19, and whether changes in microbiome composition might return to normal with the clearance of the SARS-CoV-2 virus. Here's what they found. The research team included Yun Kit Yeoh; Tao Zuo; Grace Chung-Yan Lui; Fen Zhang; Qin Liu; Amy YL Li; Arthur CK Chung; Chun Pan Cheung; Eugene YK Tso; Kitty SC Fung; Veronica Chan; Lowell Ling; Gavin Joynt; David Shu-Cheong Hui; Kai Ming Chow, Susanna So Shan Ng; Timothy Chun-Man Li; Rita WY Ng; Terry CF Yip; Grace Lai-Hung Wong; Francis KL Chan; Chun Kwok Wong; Paul KS Chan; and Siew C Ng. For their study, the team reviewed blood, stool and data from 100 patients with laboratory-confirmed SARS-CoV-2 infection. They collected serial stool samples from 27 of the 100 patients up to 30 days after clearance of SARS-CoV-2. To assess gut microbiome compositions, they shotgun sequenced total DNA extracted from stools. They measured concentrations of inflammatory cytokines and blood markers from plasma. Compared with non-Covid-19 individuals. Patients with COVID-19 showed substantially changed gut microbiome composition, with or without taking medication. Several gut bacteria with known immunomodulatory potential, such as Faecalibacterium prausnitzii, Eubacterium rectale and bifidobacteria, were significantly reduced in patients and remained low for up to a month after Covid-19 resolution. This altered gut microbiome displayed stratification with disease severity via elevated concentrations of inflammatory cytokines and blood markers such as C reactive protein, lactate dehydrogenase, aspartate aminotransferase and gamma-glutamyl transferase. The connections between gut microbiota levels, cytokines and inflammatory markers in Covid-19 patients indicate that the gut microbiome plays a significant role in Covid-19 severity possibly by modulating host immune responses. The researchers suggest that gut microbiota imbalance after Covid-19 resolution could contribute to ongoing symptoms, making it important to determine the role of gut microorganisms in inflammation and Covid-19. Read more in Gut. The researchers are variously affiliated with the Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong; the Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; the Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong; the State Key Laboratory for digestive disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong; the Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; the Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong; the Department of Pathology, United Christian Hospital, Kwun Tong, Hong Kong; the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong; the Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong; and the Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.

Celiac.com 02/23/2021 - People with celiac disease face a higher risk for developing pneumococcal pneumonia, and certain types of viral infections. Because of this, many people with celiac disease have wondered if they may have a higher risk of developing Covid-19, or of developing complications or severe Covid-19-related outcomes, if they do get it. The question was serious enough for a team of researchers to take a close look at the data to see whether people with celiac disease face an increased risk of hospitalization for Covid-19, intensive care unit admission, and/or death from Covid-19. The research team included Benjamin Lebwohl, Emma Larsson, Jonas Söderling, Bjorn Roelstraete, Joseph A Murray, Peter HR Green, and Jonas F Ludvigsson. They are variously affiliated with the Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA; the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; the Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; the Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA; and the Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden. To get the answers they needed, the team put together a population-based group study from data gathered by 28 Swedish pathology departments from 1969-2017. They first identified nearly 41,000 patients with celiac disease, defined as small intestinal villus atrophy, who were still alive on February 1, 2020. They then compared data for these patients against data for nearly 184,000 controls matched by sex, age, county, and calendar period. Using Cox proportional hazards with follow-up through July 31, 2020, they first assessed risk of hospital admission with a primary diagnosis of laboratory-confirmed Covid-19. They then assessed risk of a Covid-19 admission to intensive care unit and/or death attributed to Covid-19. They found that the overall risk of hospital admission for Covid-19 was 2.9 and 2.2 per 1000 person-years respectively. After adjusting for comorbidities, they found no significantly higher risk of hospitalization for Covid-19, or of severe Covid-19, among celiac patients. Lastly, they saw no significant difference in mortality between celiac patients and control subjects who were hospitalized with Covid-19. From this data, the team concludes that people with celiac disease are not at higher risk of hospitalization for Covid-19, or for Covid-19- related intensive care admission and/or death. Read more at DovePress.com

Celiac.com 12/28/2020 - With the outbreak of the SARS-CoV-2 virus, and cases of COVID-19 spreading worldwide, a number of people have been worried about celiac disease as a risk factor. A team of clinicians recently compiled a list of guidelines to help gastroenterologists and nutritionists in supporting their celiac disease patients during the COVID-19 outbreak. Among their insights, the team reminds readers that there is currently no data on the risk of COVID-19 and its outcomes in celiac disease. But, there is no evidence that celiac disease in itself represents a COVID-19 risk factor. Proven risk factors for COVID-19 remain old age, hypertension, diabetes, coronary artery disease, pulmonary disease, chronic kidney disease, and high body mass index. Depending on local recourses, the team encourages clinicians managing celiac patients during Covid-19 to initiate a rapid online service to address the patients’ doubts about a gluten-free diet, along with the use of POC tests for urinary gluten peptides and serological antibodies. One potential impact of COVID-19 restrictions can be reduced access to gluten-free food, which celiacs require as treatment. The paper provides helpful advice on this, and numerous other topics, including: What about hyposplenism? The team advise doctors to reassure patients that functional hyposplenism does not pose any greater risk for Covid-19. Refractory celiac disease Patients with refractory celiac disease and/or taking immunosoppressive/chemotherapic agents could face a higher risk for COVID-19, and so they should be vigilant about social distancing and shielding. Telecon clinics Telemedicine and gastroenterological/nutritional video-consulting is very helpful to patients with celiac disease. Dietary advice including Mediterranean and gluten-free dietary regimens The paper offers helpful tips on improving patient diet, especially by following a gluten-free Mediterranean diet, and consuming more antioxidant micronutrients. Read the full recommendations in BMC Gastroenterology volume 20, Article number: 387 (2020) The clinicians team included Luca Elli, Donatella Barisani, Valentina Vaira, Maria Teresa Bardella, Matilde Topa, Maurizio Vecchi, Luisa Doneda, Alice Scricciolo, Vincenza Lombardo & Leda Roncoroni. They are variously affiliated with the Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; the Department of Pathophisiology and Transplantation, University of Milano, Milan, Italy; the School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; the Department of Pathophisiology and Transplantation, University of Milano, Milan, Italy; the Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; the Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy; and the Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

Celiac.com 11/23/2020 - Since March 2020, when the World Health Organization declared coronavirus disease-2019 (COVID-19) a global pandemic, researchers and laypeople have been wondering if people with certain health conditions, such as celiac disease, might face a higher risk for contracting Covid-19. Celiac disease is a chronic immune-mediated gastrointestinal condition triggered by gluten, which numerous studies have shown to be associated with an elevated risk of respiratory infection. A team of researchers recently set out to determine whether celiac disease patients have a higher risk of contracting COVID-19. The research team included Jamie Zhen, Juan Pablo Stefanolo, Maria de la Paz Temprano, Sebastian Tedesco, Caroline Seiler, Alberto Fernandez Caminero, Enrique de-Madaria, Miguel Montoro Huguet, Santiago Vivas, Sonia Isabel Niveloni, Premysl Bercik, Edgardo Smecuol, Luis Uscanga, Elena Trucco, Virginia Lopez, Carolina Olano, Pasquale Mansueto, Antonio Carroccio, Peter H. R. Green, Andrew Day, Jason Tye-Din, Julio Cesar Bai, Carolina Ciacci, Elena Verdu, Benjamin Lebwohl, and Maria Ines Pinto-Sanchez. At this writing, the world has seen over 34 million cases of COVID-19, and more than 1 million deaths worldwide. The United States has seen over 11 million cases of Covid-19, and 250,000 deaths, with rising numbers and no end in sight. The research team carried out a cross-sectional study to determine whether patients with self-reported celiac disease have an increased risk of contracting COVID-19. Between March and June 2020, the team used local celiac disease associations, electronic newsletters, and social media to recruit patients of all ages with a self-reported celiac disease, and non-celiacs, from different countries including Argentina, Australia, Canada, Italy, Mexico, New Zealand, Spain, Uruguay, and the United States. For the study, the volunteers answered forty-one questions in a web-based survey that was available in English, Spanish and Italian using the approach proposed by Mallinckrodt and Wang. The researchers used RedCap to gather data on demographics, gluten-free diet (GFD), symptomatology, and COVID-19 testing. They used SPSS version 25 (IBM, Armonk, NY) for statistical analyses, and then compared continuous and categorical variables using the Mann-Whitney U test and chi-square test. They also performed logistic regression to gauge the influence of various factors on the likelihood of reporting a positive COVID-19 test. Independent variables included celiac disease diagnosis, age, gender, comorbidities, gluten-free diet adherence, extra precautions, and previous COVID-19 exposure. The unadjusted and adjusted odds ratios showed 95% confidence intervals. People with celiac disease tend to have more comorbidities including respiratory, cardiac, and diabetes, compared with control subjects. Patients with celiac disease were significantly less likely to have been tested for, and to have been exposed to, COVID-19, compared with control subjects. Just under 9% of of 940 participants tested for positive for COVID-19. Overall, celiac patients do not face any higher risk of contracting Covid-19 than control subjects. This analysis should provide some assurance to people with celiac disease and to clinicians that patients with celiac disease have about the same likelihood of contracting Covid-19 as the general population. However, this study did not look at whether people who have celiac disease have worse outcomes than those who do have it, and unfortunately there is some evidence that indicates that this may be the case. With Covid-19 cases higher than ever and rising, we encourage everyone to take precautions and be safe. Read more in the Clinical Gastroenterology and Hepatology The researchers are variously affiliated with the Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton, Ontario, Canada; the Hospital Dr C B Udaondo, Buenos Aires, Argentina; Alicante University General Hospital, Alicante, Spain; ||Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain; Hospital Universitario San Jorge, Huesca, Spain; University Hospital of León, Leon, Spain; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Universidad de la Republica, Montevideo, Uruguay; University of Palermo, Palermo, Italy; Columbia University, New York, New York; Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand; Walter and Eliza Hall Institute and University of Melbourne, Melbourne, Australia; and the Università degli Studi di Salerno, Salerno, Italy.

Celiac.com 10/08/2020 - InForGrowth has released its latest research report on the current market for celiac disease drugs, along with development trends and forecasts through 2026. The 2020 Celiac Disease Drug Market Report's analyses include: the macroeconomic factors influencing the growth of the Celiac Disease Drug market; key trends shaping market growth; regions growth opportunities; strategies of key market players. The report seeks to assess the size of the current and future celiac disease drug market by analyzing historical data and future projections. It offers an overviews of market segments, including product types, applications, companies, and regions. Moreover, the report includes a timely analysis on the impact of the COVID-19 pandemic on the Celiac Disease Drug market. Since the COVID-19 virus outbreak in December 2019, the disease has spread to almost 180+ countries around the globe with the World Health Organization declaring it a public health emergency. The COVID-19 pandemic will significantly affect the Celiac Disease Drug market in 2020 and beyond. The report assesses the impact of COVID-19 on the global economy, and on celiac drug markets, by analyzing: the impact of Covid-19 on global celiac drug production and demand; potential disturbances in the supply chain and market; and potential financial harm to firms and financial markets. Also included in the report are detailed analyses of each segment of the celiac disease drug market, based on product type, application, region, and major market players, including F. Hoffmann-La Roche, Johnson & Johnson, Merck, Pfizer, ADMA Biologics, Amgen, Anthera Pharmaceuticals, Bayer, Biogen, BioLineRx, Biotest, Bristol-Myers Squibb, Celgene, Takeda Pharmaceutical, Novartis, LFB Group, and Kedrion Biopharma. Source: CORONA Virus/COVID19 impact here.

Celiac.com 08/18/2020 - In the last decade or so, cases of celiac disease have been on the rise globally. Is the disease itself becoming more common, or are more people being diagnosed? A recent podcast by The People's Perspective on Medicine explores the potential surge of celiac disease with guests, Dr. Joseph Murray, MD, and Leonardo Trasande, MD, MPP. The episode also covers Covid-19, and its risks and effects in those with celiac disease, Show 1221 is called: What Explains the Recent Increase in Celiac Disease? The program explores the dramatic increase in celiac disease in the last decades, and the rise may be explained by the fact that many more people are now aware of the condition and eating gluten-free, or other facts. Dr. Murray is with the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. Dr. Murray directs a celiac disease research and clinical program focused on epidemiology, complications and mouse models of gluten sensitivity. Dr. Trasande is a professor in pediatrics, environmental medicine, and population health at New York University. He serves as Director of the Division of Environmental Pediatrics and Vice Chair for Research in the Department of Pediatrics at NYU School of Medicine. The podcast covers the topic from numerous angles, including: What Is Celiac Disease?; Diagnosing Celiac Disease; Who Gets Celiac Disease?, and Environmental Pollutants and the Increase in Celiac Disease. COVID-19 and Possible Risks Associated with Celiac Disease At about the 30 minute mark Dr. Murray discusses how COVID-19 infection can present as GI symptoms, such as diarrhea, abdominal pain, bloating, and loss of appetite. Those with celiac disease should not assume that their GI symptoms are from gluten exposure, and should consider getting tested for COVID-19. It has been shown that those with celiac disease patients have an immune system that is less responsive to vaccines, which also creates a concern about whether this will also be an issue when a COVID-19 vaccine becomes available. According to Dr. Murray, celiac disease patients also have a higher risk of pneumonia, which is of concern if it develops as a complication of COVID-19, and they also have a higher risk of shingles (herpes zoster), which might be triggered by a COVID-19 infection. Because of the additional COVID-19 risk factors mentioned, those with celiac disease should be more careful than others. Celiac disease is not considered as high a risk factor as diabetes, hypertension, and being over age 65, but those with it should consider themselves at somewhat high risk and take additional precautions, for example: Wear a mask in indoor public places at all times; Don't make unnecessary trips outside your home; Don't go into crowded shopping areas if you don't have to; Minimize your contact with people outside your household. The initial broadcast took place on July 25, 2020. The show can now be streamed online, or downloaded for free. To listed to the show: Show 1221: What Explains the Recent Increase in Celiac Disease? Join our Forum discussion on this podcast.

Celiac.com 08/06/2020 - The global pandemic of Covid, caused by coronavirus SARS-CoV2, has caused serious damage to public health and the economy. However, some of the greatest effects may be mental and emotional. Pandemic response measures have necessitated restrictions on medical visits and treatments for non-Covid conditions. The results could include lack of regular follow-up care, or the delay in consulting a doctor about ongoing symptoms, all of which can degrade a patient's quality of life. Researchers just don't know much about how the lockdown is affecting the quality of life in patients with chronic diseases, like celiac disease, and Functional Gastrointestinal Disorders (FGDIs), especially in kids. The cause of FGIDs remains unknown, though most researchers favor a biopsychosocial explanation, in which biological and psychosocial processes drive the development of FGIDs. A team of researchers recently set out to try to get an idea of the influence of the Covid pandemic on the mental health and wellbeing of patients, especially kids, with chronic diseases. The research team included Francesca Fiori Nastro; Carlo Tolone; Maria Rosaria Serra; Daniela Pacella; Angelo Campanozzi; and Caterina Strisciuglio. They are variously affiliated with the University of Naples Federico II, Department of Pediatrics, Naples, Italy; the University of Campania ``Luigi Vanvitelli,'' Department of Woman, Child and General Specialistic Surgery, Naples, Italy; the University of Naples Federico II, Department of Public Health, Naples, Italy; and the University of Foggia, Department of Medical and Surgical sciences, Italy. A number of studies have shown that children with celiac disease, even on a gluten-free diet, have a higher risk for functional abdominal pain disorders, so there was some concern about how those kids might fare during Covid lockdown. For their study, the research team assessed gastrointestinal symptoms in celiac patients at the time of the diagnosis (T0), and rates of reported FGIDs after six months (T1) of gluten-free diet. They also compared rates of FGIDs between T1 and during the lockdown for COVID-19 (T2). Data supports the idea that psychological factors, such as stress or anxiety, may play a role in the development of FGDIs. The team conducted an observational study on 71 children, aged 1 to 18 years, with clinically diagnosed celiac disease. The team also prospectively followed a group of gluten-free celiac children from the time of their diagnosis, between January 2018 and March 2019, through the study. During the Covid lockdown, the team interviewed patients by phone. Patients or their parents then completed the Rome IV, Peds QL 4.0 General Well-Being Scale and Promis anxiety surveys. At T2, during the lockdown for COVID-19, the team found reduced rates of all FGIDs, compared to T1. They also found less constipation, and a decrease in post prandial distress syndrome. The median total score of the General Well-being scale was 80.13 showing good patient quality of life, in general. More than seventy percent of patients showed no anxiety, according to the Promis anxiety questionnaires. The researchers theorize that the improvement in symptoms, wellbeing and social functioning, may result from reduced exposure to stressful events, such as school, coupled with an increased parental closeness. The study results did show that a large number of children with gastrointestinal symptoms at the time of celiac diagnosis went on to develop FGIDs when they follow a gluten-free diet. The researchers suspect that this may be due to low grade inflammation, even with negative tests for serum tissue transglutaminase IGA antibody. They suspect that these levels may fall after a year on a gluten-free diet, as reflected in the decreased frequency of FGIDs observed after one year of GFD, compared to six months. Even though this is a small study, it's a rigorous one, with solid data. Italy has been hard hit by the Covid pandemic, and even a bit of good news about kids with celiac disease seeing some overall improvements in quality of life under Covid lockdown is welcome news. Hopefully our celiac children here in the U.S. are seeing similarly improvements under the Covid lockdown. Read more at: dldjournalonline.com

Celiac.com 06/29/2020 - Coronavirus Disease 2019 (Covid-19) has killed nearly a half a million people globally, and over 120,000 here in the United States. People with celiac disease have to eat gluten-free in order to avoid negative health consequences. The pandemic fallout has included home lockdowns, food shortages, and disruptions. How concerned and/or anxious are people with celiac disease about the lockdowns and the possible shortages of gluten-free food? A team of researchers recently set out to to evaluate the perception of this in celiac disease patients who require a lifelong gluten-free diet as a therapy. The research team included Monica Siniscalchi, Fabiana Zingone, Edoardo Vincenzo Savarino, Anna D'Odorico, and Carolina Ciaccia. They are variously affiliated with the Celiac Center at Department of Medicine, Surgery, Dentistry of the Scuola Medica Salernitana at the University of Salerno in Salerno, Italy, and the Gastroenterology Unit of the Department of Surgery, Oncology and Gastroenterology at University of Padua in Padua, Italy. To get a picture of the concerns people with celiac disease are having during the pandemic, the team created an e-mail COVID-19 survey for adult patients from the University of Salerno in Campania, in the south of Italy, and the University of Padua in Venice, in northern Italy. After emailing 651 surveys to adult celiac patients, the team received 276 replies, for a response rate of just over 42%. Nearly 60% of celiacs said that they were not concerned about being more susceptible to Covid-19 just because they had celiac disease. Nearly 50% said that they were not concerned "at all" about the possible gluten-free food shortages during the pandemic. Of patients who were concerned about exposure and food shortages, most were older, female, and suffered from other comorbidities. Finally, celiac patients said that they were happy with remote consultations and explicitly asked to have them. The researchers point out that COVID-19 offers clinicians a chance to practice large-scale remote consultation for providing healthcare for people with celiac disease. According to the researchers, telemedicine is popular with celiacs, and should be integrated into the celiac healthcare regimen. The COVID-19 pandemic has affected numerous celiac patients, especially women, elderly patients, and those with comorbidities. Read more in Dig Liver Dis. 2020 May 16

Celiac.com 06/15/2020 - Usually, when a food manufacturer makes an ingredient change, even a minor one, to a food product, they must produce a new label for all the changed products. However, Covid-19 has changed that. Responding to calls from food manufacturers facing supply chain problems in the wake of the Covid-19 pandemic, the Food and Drug Administration (FDA) is relaxing some labeling requirements for certain ingredients in food in the U.S. The move will give food manufacturers the ability make small changes to the ingredients in a product without making label changes. That may mean adding, omitting, or blending ingredients to meet the product needs. The FDA guidance on the matter states that such labeling changes "should not cause any adverse health effect, including those from gluten and food allergens." The guidance states that ingredients used as substitutes should not alter any voluntary nutrient or health claim on the label, such as gluten free, and that ingredients that are the reason for the label should not be changed. Basically, “Manufacturers should avoid substitutions that could result in a safety concern without making a conforming label change or providing other means to inform consumers of the change,” the new guidance says. The FDA wants to avoid any risk of allergic reaction due to any such substitutions, and the temporary rule change reflects that. The safety, claims, and prominence section of the guidance specifically states that no gluten ingredient can be used as a substitute for a gluten-free ingredient. The flexibility in labeling will continue for the duration of the public health emergency declared by the Department of Health and Human Services, including extensions. The FDA notes that it may consider extensions, depending on how quickly supply chains return to normal. For questions, answers, and more information, read the FDA's page on Food Safety and the Coronavirus Disease 2019 (COVID-19)

Celiac.com 05/21/2020 - Currently more than 2.4 million people worldwide have contracted COVID-19, suffering symptoms ranging from fever and dry cough, to temporary loss of smell and taste, to extreme respiratory distress requiring oxygen, and even intubation. In many places, hospital resources have been taxed, as large numbers of people have sought medical help. Until recently, young people, especially children were thought to be generally safe from the virus and its effects. That has changed recently, as new information has come to the attention of doctors. In one recently finding, researchers noted that "three children in New York have died from a rare inflammatory syndrome believed to be linked to the novel coronavirus." Meanwhile, dermatologists across the globe are seeing large numbers of children with inflammation of the blood vessels in the hands and feet. Dubbed “COVID fingers," and marked by purple-red papules on the fingers and toes, which resemble chilblains. The condition is officially known as "erythema pernio," and is defined by the National Institutes of Health as a “itchy and/or tenderness or reddish or purplish bumps that appear in reaction to cold.” Typically, clinicians see fewer than 200,000 cases in the United States each year. The condition is common in lupus, and other autoimmune conditions, such as celiac disease, viral hepatitis and HIV. Patients suffering from COVID fingers tend to be young, and may not show other symptoms. Amy Paller, MD and chair of the Department of Dermatology at Northwest University Feinberg School of Medicine, says that, in the wake of the COVID-19 pandemic, dermatologists are seeing major surges in the numbers of young patients with symptoms of erythema pernio. “Generally, these are perfectly healthy children with mild symptoms, and frankly, since some of these tests are still difficult to access, we don’t know for sure if they have COVID-19,” says Paller. “So I think we will find out much more next week or in two months.” Are COVID fingers a Sign of Asymptomatic COVID-19? Italian clinicians noticed the first cases of painful blisters and red sores in the fingers and toes of children with COVID-19 in late March. That COVID-associated surge in erythema pernio in children with COVID is a major reason American dermatologists think that the two conditions are connected. Symptoms of erythema pernio usually appear within hours of exposure to cold temperatures, and can lead to more painful skin reactions such as “blisters, pustules, scabs. and ulcers." Do you or anyone you know suffer from erythema pernio, or "COVID-fingers?" Have you or they been tested for COVID? Share your story below. Read more on "Covid fingers" in children at Explica.co.

Celiac.com 05/20/2020 - After seeing her doors closed and her gluten-free cosmetic production stopped, due to coronavirus, a cosmetics entrepreneur is now making up to 1,000 bottles of gluten-free hand sanitizer every day to fight the coronavirus. Sensitive to gluten, and facing difficulty in finding guaranteed gluten-free skin care products, Dr. Liia Ramachandra used her pharmaceutical background to found gluten-free cosmetics brand, EpiLynx. After the Covid-19 pandemic shuttered her production facility, Ramachandra quickly retooled, and turned her efforts toward producing gluten-free hand sanitizer. Experts say most hand sanitizers do not contain gluten ingredients, are safe for those with gluten allergies. However, because many brands are not labeled gluten-free, some customers who are trying to avoid gluten for health reasons can become confused, and avoid them unnecessarily. Faced with a closed shop, and a shortage of hand sanitizer, Ramachandra decided to switch to hand sanitizer. Being gluten-free herself, and specializing in gluten-free cosmetics, she decided to "start making [gluten-free] hand sanitizers," she told reporters. Using all-natural ingredients, she can produce up to 1,000 bottles of gluten-free hand sanitizer per day. Ramachandra's hand sanitizer is labeled 'gluten-free' and safe for people with celiac disease or other medical gluten intolerances. However, with hand sanitizer in short supply, Ramachandra is stepping beyond the gluten-free market to provide sanitizer to companies like the cleaning service Molly Maid. Do you have any gluten-free Covid-19 stories to share? Comment below. Read more at BusinessInsider.com

Celiac.com 05/19/2020 - A Kentucky man with celiac disease has shared his experience with Covid-19 with the local press. His story is both illuminating and quite sobering. The man's name is Greg Pritchett, and his story of Covid-19 infection and survival is harrowing. Pritchett says that in the beginning, he didn't feel too bad. The sturdy 6-foot-3, 62-year-old Henderson, Kentucky resident was in reasonably good shape and good health, except for having asthma and celiac disease. He watched his diet carefully, did regular yoga and worked out a couple of days a week. By his own account, he was “in very good shape compared to the norm for people in Kentucky my age.” That may be why he is still alive. Part one of Pritchett's story begins on Saturday, March 14, when he began to suffer from body aches, and runs until his wife took him to the local medical clinic, only to be forced to say goodbye to him as they sent him over to St. Vincent Hospital in Evansville on Wednesday, April 1. In between, Pritchett describes the progression of Covid-19, and his struggles as his condition continued to worsen and the first crucial symptom of COVID-19 appeared as he had a fever of 101.7 degrees. He also recounts his bouts of vomiting and significant abdominal pain. Covid-19 left him unable to eat. Fortunately, his wife was able to bring him some protein shakes to provide nourishment and help keep him hydrated. He managed to keep the shakes down. He tells of the difficulty he had in simply walking twenty steps to the bathroom, and how coughing would leave him exhausted. Fever. Coughing. Shortness of breath after the short walk from bed to his bathroom. At one point, he noticed that he showed all three major symptoms of COVID-19. Eventually, he would test positive. Part two of Pritchett's story details his hospitalization and recovery from Covid-19, beginning on April 1st, and ending with his discharge from the hospital on Good Friday, April 10. At the time of the interview, Pritchett was recovering at home and using the steps leading to his front door to rebuild his strength after more than a month of being ill. Pritchett shares his two-part story of Covid-19 infection and survival with The Gleaner: Coronavirus Survivor Diary, PART I Coronavirus Survivor Diary, PART II