Dermatitis herpetiformis celiac disease

Throughout this publication, when not otherwise specified, dermatitis herpetiformis is included under the general term celiac disease. 

TABLE 6.1 Pivotal in vivo clinical studies of the effects of oats in patients with celiac disease and dermatitis herpetiformis... 

Abs, Antibodies CD, celiac disease DH, dermatitis herpetiformis Dx, Diagnosis EM, endomysial antibodies GI, gastrointestinal GFD, gluten-free diet IELs, intraepithelial lymphocytes IFN, interferon Lab, laboratory tTG, tissue transglutaminase antibodies Ret, reticulin IH, immunohistochemistry. 

Janatuinen et al. (1995) were the first to evaluate the possible toxicity of oats in a large controlled study. Since then, a number of studies (Table 6.1) have assessed the safety of oats consumption by individuals diagnosed with celiac disease and dermatitis herpetiformis. Most studies were conducted on adults, with a smaller number of studies performed on children. 

Available scientific data evaluating the introduction of pure oats in the gluten-free diet of patients with celiac disease and dermatitis herpetiformis indicates that moderate amounts of pure oats are well tolerated by the majority of these individuals who are either in remission or newly diagnosed. The term "pure oats" is used to indicate oats uncontaminated with gluten from other cereal grains, like wheat, barley, and rye, as detected by current test methods. Based on pivotal clinical trials in the published literature, the amount of pure oats considered within safe limits is 50-70 g/day for adults and 20-25 g/day for children. 

Peraaho, M., Collin, P., Kaukinen, K., Kekkonen, L., Miettinen, S., and Maki, M. (2004a). Oats can diversify a gluten-free diet in celiac disease and dermatitis herpetiformis. J. Am. Diet. Assoc. 104,1148-1150. 

Intrinsic diseases of the small intestinal mucosa may impair mineral absorption. Such conditions as celiac sprue, dermatitis herpetiformis, infiltrative lymphomas, and occasionally inflammatory bowel disease produce diffuse mucosal damage. Protein energy malnutrition causes similar damage, and tropical enteropathy affects part of the population of developing countries living under adverse nutritional and hygienic conditions. 

Primary IgA nephropathy an immune-complex-mediated disease in which IgA deposits and other pathologic lesions are found in kidney tissues. In contrast, Henoch-Schonlein purpura is a systemic disease that is believed to be closely linked to IgA nephropathy because they share similar immunohistologic features. Only the joints, skin, and gastrointestinal tract are affected in Henoch-Schonlein purpura. Mesangial deposition of IgA immune complex is also seen in patients with celiac disease and dermatitis herpetiformis, possibly due to an increased exposure to antigens. Patients with chronic liver disease may have IgA nephropathy because of reduced clearance of IgA immune complexes. Secondary IgA nephropathy may be present in patients with different connective tissue diseases, carcinomas, and HIV infection. 

In patients with celiac disease and dermatitis herpetiformis, no adverse effects were seen after ingestion of 2.5 g of the protein avenin daily (equivalent to 300 g of oats, or about 10 bowls of oatmeal) for 5 days. Biopsies of the small intestines indicated that that avenin did not change the ratio of the villous height to the crypt depth, the height of enterocytes, or intraepithelial lymphocyte counts (Hardman et al. 1999). 

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