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Food Allergy in Children: Celiac Disease

Food Allergy in Children: Celiac Disease . Gila Greenbaum NUSC 467 Dr. Tucker Major Report. Introduction: Food Allergy. Food allergies: immune system reactions that occur after eating specific foods A ffect 6-8 % of children under age 5

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Food Allergy in Children: Celiac Disease

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  1. Food Allergy in Children: Celiac Disease Gila Greenbaum NUSC 467 Dr. Tucker Major Report

  2. Introduction: Food Allergy • Food allergies: immune system reactions that occur after eating specific foods • Affect 6-8% of children under age 5 • Celiac disease (CD): growing health concern • CD: autoimmune disorder with reaction to gluten • Gluten: protein of wheat, barley, rye • Gliadin: toxic fraction of gluten

  3. Introduction: Celiac Disease • Characterized by malabsorption & failure to thrive • Consequences: stunting of growth & intellectual development, epilepsy, dental abnormalities • GI Symptoms: diarrhea, weight loss, abdominal pain, vomiting, dyspepsia, bloating, constipation • Non GI symptoms: anemia, dementia, lethargy, neuropathy, seizures, depression • Less common presentations: dermatitis herpetiformis, hypoproteinemia, hypocalcemia, & elevated liver enzyme levels

  4. Prevalence/Incidence • CD: public health concern, under diagnosed • Number of cases increasing, from less than 1 per 100,000 in the 1950s to roughly 20 per 100,000 in 2003 • Recognized worldwide, common in all ethnic groups • 1 in 133 children in the United States have CD • 2010: approximately 2.2 million children under 5 years of age living with CD

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  6. Risk factors 1. Genetics: • Close relatives of people with CD have a 5%-10% chance of developing the disease • CD is twice as frequent in females than males 2. Environmental: • Children born during the summer had a higher risk • GI surgery, pregnancy, and viral infections (adenovirus) • Dietary patterns of infants: Introducing gluten too early can increase CD development • Breast feeding protects against CD 3. Immunologically based inflammation

  7. Diseases or conditions associated with high incidence of CD: common with type 1 DM, thyroid disease, Addison disease, osteoporosis, Down syndrome, IDA, IBS, and rheumatologic complaints

  8. Health Burden • Increased morbidity • 42,000 deaths annually • In 2008, deaths related to CD accounted for 4% of all childhood diarrheal mortality • Variety of symptoms is a major impediment to diagnosis Health complications: • Refractory sprue: persistent symptoms and villous atrophy, despite adherence to a gluten-free diet • Autoimmune disorders • Cancer (adenocarcinoma, T cell lymphoma) • Nutrient deficiencies: folic acid, vitamin B12, fat-soluble vitamins, iron, and calcium

  9. Economic Burden • Early diagnosis reduces medical costs of care: reduction in office visits, lab diagnostic, & endoscopy procedures • Undiagnosed CD: negative economical consequences due to lost working-time and misspent healthcare cost • Direct medical costs decreased $2118 /year • Average costs reduced $1764 following CD diagnosis • Expense of diagnostic test can prevent CD detection • High cost of the gluten-free products: Gluten free diet incurs extra costs of $1,200-1,300 per patient annually

  10. Prevention Approaches 1. Primary: avoidance of disease development • Recognizing risk factors 2. Secondary: Early diagnosis & treatment • Increase availability of serologic assays, diagnostic tests, population-based screening • Increasing awareness of epidemiology & diverse manifestations 3. Tertiary: reduce negative impact of established disease • Adherence to gluten-free diet for epithelial healing • Implement immediately: as children age, healing time increased

  11. Prevention Approaches • Dietary non-adherence: common in children & teenagers Why? • Inconvenience of purchasing & preparing gluten-free foods • Poor availability of gluten-free products • Poor palatability • Inadequate dietary counseling • Social, cultural, and peer pressures • Transition to adolescence • Healthcare team requires RD to monitor nutritional status & dietary adherence • Moderate amounts of oats can be consumed to increase compliance

  12. Prevention Approaches Non-dietary therapies: • Recombinant enzymes that digest gliadin fractions • Probiotics to improve tolerance • Patient-support organizations • Correction of intestinal barrier defect against gluten entry • Blocking gliadinpresentation by human leukocyte antigen blockers • Techniques to improve antigen tolerance • Early exposure to antigen through breastfeeding • Studying frequency and amount of antigen exposure

  13. References • Green, P.H.R et al. Celiac Disease. N Engl J Med 2007;357:1731-43. • Hoffenberg, E.J. et al. Clinical Features of Children With Screening-Identified Evidence of Celiac Disease. Pediatrics 2004;113;1254 • Ivarsson, A. et al. Breast-feeding protects against celiac disease. Am J ClinNutr2002;75:914–21. • Janatuinen, E.K. et al. A comparison of diets with and without oats in adults with celiac disease. N Engl J Med 1995;333:1033-7. • Long, K.H. et al. The economics of celiac disease: a population-based study. Aliment PharmacolTher. 2010 Jul;32(2):261-9. • Mahan, L.K. et al. Krause’s Food and Nutrition Therapy. Saunders Elsevier, Canada, 2008. • Murray, J.A. et al. Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. Am J ClinNutr2004;79:669–73. • Maki, M. et al. Prevalence of Celiac Disease among Children in Finland. N Engl J Med 2003;348:2517-24. • Murray, J.A. The Widening Spectrum of Celiac Disease. Am J ClinNutr1999;69:354–65 • Stone, M.L. et al. Age related clinical features of childhood Coeliac disease in Australia. BMC Pediatrics 2005, 5:11

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