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(19) Prevalence of serum antibodies reactive with wheat gliadin and other dietary proteins in dermatitis herpetiformis
Author(s) -
LewisJones M.S.,
Barnes R.M.R.,
Finn R.,
Johnson P.M.
Publication year - 1987
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.1987.tb12037.x
Subject(s) - dermatitis herpetiformis , medicine , dermatology , family medicine , disease
It is established that, in addition to a gluten‐sensitive enteropathy, some patients with dermatitis herpetiformis (DH) develop serum antibodies to wheat gliadin. Since a strict gluten‐free diet (GFD) improves the enteropathy with a concurrent decrease in anti‐gliadin antibodies, this may reflect altered gut mucosal permeability related specifically to ingestion of wheat. In the present study, 44 adult patients with DH (confirmed by direct immunofluorescence) were evaluated for the presence of serum antibodies reactive with common dietary proteins, including wheat gliadin, using a solid‐phase immunoassay (ELISA). The immunoglobulin class and subclass of these antibodies was determined and their changes over a period of time in response to a GFD evaluated by serial measurements. 75% of DH patients had serum antibodies reactive with either bovine milk (AMA), chicken ovalbumin (AOA) or gliadin (AGA), compared with 33·9% of 232 healthy adult controls ( P < 0·001); however, there was no significant difference between their prevalence in DH patients on a GFD (16/23) and their prevalence in patients not on a GFD (14/21). AGA were detected in 34% ( P < 0·001), AMA in 43·1% ( P < 0·005) and AOA in 45·4% ( P < 0·001) of DH patients, compared with controls, and these antibodies were predominantly of the IgG class, although some DH sera also contained IgA antibodies, notably anti‐milk. The IgG subclass distribution of AOA and AMA—to IgG 4 and to IgG 4 and IgG 2 , respectively—was similar to that in healthy adults. However, whereas AGA in healthy adults were usually of the IgG 4 subclass, no restriction to a predominant IgG subclass could be demonstrated for AGA in DH sera. Serum levels of AGA followed serially up to one year tended to decline in patients commencing a GFD compared to patients not on a GFD; in contrast, we were unable to demonstrate a similar trend in serial levels of AMA and AOA over this period. Taken together, these data suggest that there may be a persistent, but relatively non‐specific, defect in intestinal permeability in DH.