Cassidy, Celiac Disease and Allergies

Cassidy is one of more than two million Americans living with celiac disease.

I recently received a cheerful yet sobering text message from my teenage niece, Cassidy. In the midst of the usual niceties, she casually informed me that she was diagnosed with celiac disease, a condition caused by intolerance to gluten, a protein found in wheat and other common grains. As an unrestrained cookie consumer, I found this to be troubling news indeed.

Celiac disease is characterized by a slew of unpleasant symptoms, including abdominal pain, nausea, and diarrhea. It is classified as an autoimmune disease, not a food allergy. Consequently, there are significant differences between celiac disease and a food allergy, but there are also significant similarities. Among the most significant is that they both involve an inappropriate reaction by the immune system to a normally harmless food.

Fortunately, there is an effective treatment for celiac disease, and it’s quite simple: stick to a lifelong gluten-free diet. Unfortunately, that means that my niece will have to commit to lifetime of forgoing her mother’s homemade macaroni and cheese and a cornucopia of other wheat flour-based treats. Doable? Yes. Desirable? No.

But my niece is far from alone in her dietary restrictions. How many of us today know someone who has celiac disease or a food allergy, but, not so many years ago, didn’t know of a single person who had either? Research shows that young people are 4.5 times more likely to have celiac disease today than they were in the 1950s. And a recent report from the National Institutes of Health Expert Panel on Food Allergy Research found that food allergies overall appear to be increasing, with peanut allergies growing dramatically. This is supported by the observations of Dr. Joshua Boyce, a researcher and allergist at the Brigham and Women’s Hospital Allergy and Immunology practice in Chestnut Hill. “It seems the primary reason for referring now to a pediatric allergist is food allergy,” said Boyce. “You could almost say it’s not a disease anymore. It’s part of the human condition.”

So why have food allergies and autoimmune disorders increased so dramatically in recent years?

One theory is that we’re too clean. Many allergy and immunology experts contend that purified water, antibiotics, vaccines, hand sanitizers, and other aspects of our hygienic society have replaced our immune system’s role in fighting off bacteria and other environmental microbes, and, thus, our immune system seeks out other substances to attack – e.g., the proteins in eggs, wheat, and nuts or our own body tissue. This hygiene hypothesis has compelled many European researchers to examine “the farming effect,” wherein early exposure to a diverse variety of microbes seems to prevent the development of allergies in children who grow up on farms. Indeed, recent findings have consistently shown that children who live on farms have significantly far fewer cases of asthma and food allergies than children who do not. But there are plenty of other theories as to why allergy and autoimmune disorder cases have proliferated – genetic predisposition, children eating peanuts when their immune systems are immature, genetic modification of foods, roasted peanuts producing allergy-triggering compounds, or children born by caesarean section having reduced exposure to healthy bacteria while passing through the birth canal.

Although it’s important to find out what triggers allergies and prevent people from ever getting them, it’s also important to help our adult patients who have been living with allergies for years. Therefore, while some researchers continue to search for reasons why the problem exists, other allergy researchers are focusing on finding methods to counteract the problem in patients who already have allergies. Dr. Boyce, for instance, has been exploring whether a certain protein molecule could act as an off-switch for allergic reactions. Meanwhile, his colleague, Dr. Mariana Castells, has been working on modifying allergens so that they spur protective responses instead of allergic responses. These modified allergens would then be used to develop a vaccine.

A significant amount of celiac disease research, on the other hand, has focused on understanding the underlying genetic component of the disease. BWH rheumatology researchers contributed to a recently released study that found a strong genetic correlation between celiac disease and rheumatoid arthritis. By learning more about the roles of these and other genes in the onset and development of celiac disease, researchers hope to ultimately develop new treatments for celiac patients.

As this research progresses and our allergy and immunology knowledge expands, there is hope that someday nearly every person in the world will be able to safely enjoy a white chocolate macadamia nut cookie. That would be patient satisfaction.

– Chris P

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