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Celiac.com 03/06/2017 - Dermatitis herpetiformis is an autoimmune skin-blistering disease which is commonly associated with celiac disease. The most common treatments are a gluten-free diet along with the addition of dapsone. DH that does not respond to either a gluten-free diet, or to dapsone, is treated with other immune-suppressing medications, but results have been mixed. Now, for the first time, a patient treated with rituximab therapy had resolution of both his pruritus and skin rash. "In addition, the levels of both anti-tissue and anti-epidermal transglutaminase antibodies normalized," said Dr. Ron Feldman of Emory University School of Medicine. Writing in JAMA Dermatology, Dr. Feldman and colleagues describe a man in his 80's with a five-year history of worsening DH. He was put on a gluten-free diet along with dapsone 50 mg daily, but his pruritic rash persisted. Dapsone was discontinued because of worsening anemia. He began treatment with 3 g sulfasalazine daily, but this was discontinued due to gastrointestinal symptoms. His disease worsened, and he was put on a tapering course of prednisone from 40 mg to 10 mg daily along with azathioprine titrated up to 2.5 mg/kg daily. However, his disease continued to worsen over subsequent months. He was then treated with rituximab according to the protocol used to treat lymphoma: four weekly infusions of 375 mg/m2. "Rituximab," says Dr. Feldman, "has already shown efficacy in the treatment of other autoimmune blistering diseases such as pemphigus and pemphigoid and may have relevance with other B cell mediated diseases in dermatology." Thirteen months after treatment, the patient experienced complete resolution of pruritus and other symptoms of DH, as well as normalization of antibodies against both epidermal and tissue transglutaminases. Not only was there a normalization of antibodies against both epidermal and tissue transglutaminases, the patient went into remission and has remained symptom-free for up to a year and a half thus far, said Dr. Feldman. There is some cause for excitement here, since rituximab is well tolerated and can potentially provide long lasting remission with removal of pathogenic autoimmune B cells. Dr. Feldman concedes that their patient did not have serious gastrointestinal symptoms, but remains "hopeful that rituximab may provide similar benefits for patients with celiac disease, in which anti-tissue transglutaminase antibodies play a role, although further research will need to be done to confirm this." Source: JAMA Dermatology, online December 28, 2016
For 10+ years I had terrible symptoms that I had no idea what they were caused by, leaving doctors stumped. I had everything from diarrhea, vomiting, severe abdominal pain, joint pain and inflammation, numbness and tingling in my toes, bone pain, sore tongue, burning gums, inability to gain weight, and acid reflux. I had a normal HIDA scan, normal liver, a small cyst in my gallbladder, H. Pylori in stomach, gastroparesis, and gastroenteritis. Finally at the age of 21 I was referred to a GI doctor and the first test he did on me was an endoscopy. It came back showing flattened villi in my small intestine and all he said to me was "it looks like Celiac Disease" then left it at that. I went back to him two weeks after having gone on a gluten-free diet and told him I was feeling better. I basically got no response from him and it didn't seem to matter to him either way if I felt better or not. But I continued to eat gluten-free and after a few months, I felt "normal" again. After nearly 5 years of being gluten-free, I've noticed my symptoms are coming back. They're not as severe and not all are back, but I'm still feeling sick. I have abdominal pain, diarrhea/constipation, and I've noticed if I don't take my B-complex vitamin I get irritability and mouth soreness. I don't ever go out to eat, I make most everything from scratch, and the only processed foods I eat are ones that are certified gluten free. I've thought about going on an elimination diet, but I'm breastfeeding and don't want to disturb the quality or quantity of my milk. Why are my symptoms coming back after all this time? Has anyone else had the same experience? What was the outcome? Thanks in advance.
The Journal of Psychosomatic Research Volume 55, Issue 6, Pages 573-574 (December 2003) Celiac.com 12/19/2003 - According to Italian researchers, brief but recurring bouts of depression and other mood disorders are significantly more common in those with celiac disease than those without the disorder. The researchers conducted a study that looked at 36 clinically diagnosed celiac disease patients and compared them to 144 healthy controls. The study found that those with celiac disease had "significantly elevated risks for major depressive disorders," including major depressive disorders, dysthymic disorders, adjustment disorders and panic disorders. The researchers suspect malabsorption of tryptophan, which can lead to a decrease in serotonin synthesis, as a cause for the elevated mood disorder risk. Another possible cause is the cytokines which are produced in immune reactions that may exert an effect on brain circuits related to mood regulation. More studies are necessary to determine the exact causes.