Plain language summary
Celiac disease and nonceliac wheat sensitivity (NCWS) are both disorders, which are characterised by both stomach and non-stomach related symptoms, following the ingestion of wheat. Celiac disease has been associated with diseases where the body’s immune system attacks its own cells, otherwise known as autoimmunity, however there is little research regarding this and how NCWS may be involved. This study of 713 individuals aimed to determine the presence of a blood marker, which indicates autoimmunity, amongst individuals with celiac disease and NCWS. The results showed that markers of autoimmunity were present in patients with wheat-related disorders. It was concluded that those with wheat-related disorders do display markers of autoimmunity. This study could be used by healthcare professionals to understand that testing individuals with wheat-related disorders for autoimmune diseases, may give a false positive due to the presence of the wheat-related disorder expressing markers of autoimmunity. To negate this effect, differentiation between the markers displayed in autoimmune diseases may be required to reach a definitive diagnosis.
Abstract
BACKGROUND AND AIMS There has been broad interest to explore the presence of autoimmunity among wheat-sensitive individuals, but neither the pathogenesis nor the relevance has been established. In this study, we evaluated the frequencies and levels of autoantibodies, which are important biomarkers of autoimmunity, in subjects with wheat-related disorders and controls. Anti-nuclear antibodies (ANA) and the specific ones against extractable nuclear antigens (ENA) were investigated. METHODS A total of 713 subjects who showed symptoms related to wheat ingestion were addressed to Vibrant America Clinical Laboratory from December 2015 to November 2017. Serum samples were collected from all subjects and tested with a wheat protein antibody panel (IgG and IgA to 18 proteins at the peptide level) and an autoantibody panel (ANA by immunofluorescence analysis and 10 ENA antibodies). Retrospective analysis was completed using de-identified clinical data and test results. RESULTS In the retrospective analysis, 38 (5%) were seropositive in a Celiac Disease panel, 491 (83%) were seropositive in a wheat protein antibody panel "Wheat Zoomer," and 84 (12%) were seronegative in both panels. Anti-nuclear antibodies were detected in similar portions of the celiac disease subjects (13%), the Wheat Zoomer-positive subjects (12%), and seronegative controls (15%), which is also very close to the reported occurrence of ANA positivity (15%) in the healthy population. The prevalence of anti-ENA was reported to be less than 2% in the general population; however, our study found it to be much higher in the celiac disease subjects (29%) and the wheat-sensitive subjects (27%), compared with a smaller proportion of seronegative controls (19%). The prevalence of anti-histone was especially prominent among the celiac disease subjects (73%) and the Wheat Zoomer-positive subjects (60%). CONCLUSIONS High proportions of wheat-related disease subjects carry ENA antibodies that are important specific biomarkers of autoimmunity.
Methodological quality
Jadad score
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