Open AccessCytokine release after gluten ingestion differentiates coeliac disease from self‐reported gluten sensitivity
Author(s) -
TyeDin Jason A,
Skodje Gry I,
Sarna Vikas K,
Dzuris John L,
Russell Amy K,
Goel Gautam,
Wang Suyue,
Goldstein Kaela E,
Williams Leslie J,
Sollid Ludvig M,
Lundin Knut EA,
Anderson Robert P
Publication year - 2020
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640619874173
Subject(s) - medicine , gluten , cytokine , coeliac disease , ingestion , gastroenterology , crossover study , gluten free , placebo , gliadin , immunology , disease , pathology , alternative medicine
Background Diagnosing coeliac disease (CD) in patients on a gluten‐free diet (GFD) is difficult. Ingesting gluten elevates circulating interleukin (IL)‐2, IL‐8 and IL‐10 in CD patients on a GFD. Objective We tested whether cytokine release after gluten ingestion differentiates patients with CD from those with self‐reported gluten sensitivity (SR‐GS). Methods Australian patients with CD ( n = 26) and SR‐GS ( n = 18) on a GFD consumed bread (estimated gluten 6 g). Serum at baseline and at 3 and 4 h was tested for IL‐2, IL‐8 and IL‐10. Separately, Norwegian SR‐GS patients ( n = 49) had plasma cytokine assessment at baseline and at 2, 4 and 6 h after food bars containing gluten (5.7 g), fructan or placebo in a previous double‐blind crossover study. Results Gluten significantly elevated serum IL‐2, IL‐8 and IL‐10 at 3 and 4 h in patients with CD but not SR‐GS. The highest median fold‐change from baseline at 4 h was for IL‐2 (8.06, IQR: 1.52–24.0; P < 0.0001, Wilcoxon test). The two SR‐GS cohorts included only one (1.5%) confirmed IL‐2 responder, and cytokine responses to fructan and placebo were no different to gluten. Overall, cytokine release after gluten was present in 22 (85%) CD participants, but 2 of the 4 non‐responders remained clinically well after 1 y on an unrestricted diet. Hence, cytokine release occurred in 22 (92%) of 24 ‘verified’ CD participants. Conclusions Gluten challenge with high‐sensitivity cytokine assessment differentiates CD from SR‐GS in patients on a GFD and identifies patients likely to tolerate gluten reintroduction. Systemic cytokine release indicating early immune activation by gluten in CD individuals cannot be detected in SR‐GS individuals.