Asthma, Atopic Dermatitis, and Allergic Rhinitis in Pediatric Celiac Disease: A Case-control Study
Abstract
Celiac disease is a gluten-induced immune-mediated enteropathy. Recent studies suggest an increasing association between celiac disease and atopic conditions such as asthma, atopic dermatitis, and allergic rhinitis, although the underlying mechanisms are not fully understood.
In this matched case-control study, the prevalence of asthma, atopic dermatitis, and allergic rhinitis was evaluated among 173 children with celiac disease and 173 age- and sex-matched healthy controls in Zahedan, Iran, in 2023. The diagnosis of celiac disease was based on European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines. Allergic conditions were assessed using the International Study of Asthma and Allergies in Childhood questionnaire and confirmed through clinical evaluation.
Children with celiac disease had a significantly higher prevalence of asthma (12.1% versus 5.8%; odds ratio, 2.25; 95% confidence interval, 1.15 to 4.05) and allergic rhinitis (29.5% versus 14.5%; odds ratio, 2.47; 95% confidence interval, 1.4 to 4.26) compared to controls. There was no significant difference in the prevalence of atopic dermatitis between the two groups (12.1% versus 9.2%; odds ratio, 1.35).
These results indicate that children with celiac disease are at increased risk for certain respiratory allergic diseases, particularly asthma and allergic rhinitis. This highlights the need for integrated care between gastroenterology and allergy specialists. Further research is needed to clarify the shared immunological pathways involved.
2. Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, et al. Celiac disease: a comprehensive current review. BMC Med. 2019;17(1):142.
3. Lebwohl B, Rubio-Tapia A. Epidemiology, presentation, and diagnosis of celiac disease. Gastroenterology. 2021;160(1):63–75.
4. Hujoel IA, Reilly NR, Rubio-Tapia A. Celiac disease: clinical features and diagnosis. Gastroenterol Clin North Am. 2019;48(1):19–37.
5. Sahin Y. Celiac disease in children: a review of the literature. World J Clin Pediatr. 2021;10(4):53–71.
6. El-Metwally A, Toivola P, AlAhmary K, Bahkali S, AlShail E, Alnasyan A, et al. The epidemiology of celiac disease in the general population and high-risk groups in Arab countries: a systematic review. Biomed Res Int. 2020;2020:6865917.
7. Yavuzyilmaz F, Ozdogan S, Urganci N, Usta MK. Frequency of asthma and atopic diseases in inflammatory bowel disease and celiac disease. J Coll Physicians Surg Pak. 2019;29(5):435–9.
8. Krishna MT, Subramanian A, Adderley NJ, Nirantharakumar K, Arfeen M, Gkoutos G, et al. Allergic diseases and long-term risk of autoimmune disorders: longitudinal cohort study and cluster analysis. Eur Respir J. 2019;54(5):1900476.
9. Patel B, Wi CI, Hasassri ME, Al Othman B, Park MA, Weaver AL, et al. Heterogeneity of asthma and the risk of celiac disease in children. Allergy Asthma Proc. 2018;39(1):51–8.
10. Mearns ES, Taylor A, Boulanger T, Gauthier A, Krane MK, Leffler DA, et al. Systematic literature review of the economic burden of celiac disease. Pharmacoeconomics. 2019;37(1):45–61.
11. Shalom G, Kridin K, Raviv KO, Freud T, Comaneshter D, Cohen AD, et al. Atopic dermatitis and celiac disease: a cross-sectional study of 116,816 patients. Am J Clin Dermatol. 2020;21(1):133–8.
12. Rahimian N, Aghajanpour M, Jouybari L, Jafarnejad S, Firoozi D, Soltani S, et al. The prevalence of asthma among Iranian children and adolescent: a systematic review and meta-analysis. Oxid Med Cell Longev. 2021;2021:6671870.
13. Eichenfield LF, Stripling S, Fung S, Langley RG, Block J, Call RS, et al. Recent developments and advances in atopic dermatitis: a focus on epidemiology, pathophysiology, and treatment in the pediatric setting. Paediatr Drugs. 2022;24(4):293–305.
14. Chong SN, Chew FT. Epidemiology of allergic rhinitis and associated risk factors in Asia. World Allergy Organ J. 2018;11(1):17.
15. Oliveira EF, Penedo C, Valle SOR, Kuschnir FC. Validation and reproducibility of the International Study of Asthma and Allergies in Childhood (ISAAC) written atopic eczema questionnaire for telephone survey in children aged 6–7 years. An Bras Dermatol. 2022;97(2):173–8.
16. Castro-Rodriguez JA, Forno E, Celedón JC, Soto-Quiros ME, Avila L, Laskey D, et al. The Asthma Predictive Index: a practical tool for asthma prevention? J Allergy Clin Immunol. 2020;145(2):604–15.
17. Ludvigsson JF. Celiac disease confers a 1.6-fold increased risk of asthma: a nationwide population-based cohort study. J Allergy Clin Immunol Pract. 2018;9(9):1–2.
18. Shokouhi Shoormasti R, Pourpak Z, Fazlollahi MR, Kazemnejad A, Kazemnejad-Leili E, Gharagozlou M, et al. The prevalence of allergic rhinitis, allergic conjunctivitis, atopic dermatitis and asthma among adults of Tehran. Iran J Public Health. 2018;47(11):1749–55.
19. Khuhro AA, Fazal ur Rehman, Ali W, Awan MS, Arain TM, Soomro AH, et al. Asthma and allergic rhinitis amongst children having celiac disease. Prof Med J. 2019;26(12):2151–5.
20. Wandalsen NF, Gonzalez C, Wandalsen GF, Sole D. Evaluation of criteria for the diagnosis of asthma using an epidemiological questionnaire. J Bras Pneumol. 2009;35(3):199–205.
21. Ellul P, Vassallo M, Montefort S. Association of asthma and allergic rhinitis with celiac disease. Indian J Gastroenterol. 2005;24(6):270–1.
22. Infantino C, Francavilla R, Vella A, Magistà AM, Ierardi E, Miniello V, et al. Role of vitamin D in celiac disease and inflammatory bowel diseases. Nutrients. 2022;14(23):5154.
23. Wei Choo CY, Yeh KW, Huang JL, Chen LC, Chen YM, Tsai YF, et al. Oxidative stress is associated with atopic indices in relation to childhood rhinitis and asthma. J Microbiol Immunol Infect. 2021;54(3):466–73.
24. Kreiner E, Waage J, Standl M, Altug H, Bønnelykke K, Melén E, et al. Shared genetic variants suggest common pathways in allergy and autoimmune diseases. J Allergy Clin Immunol. 2017;140(3):771–81.
25. Hood J, Mason AM. Diffuse pulmonary disease with transfer defect occurring with coeliac disease. Lancet. 1970;1(7644):445–7.
26. Kero J, Gissler M, Hemminki E, Isolauri E. Could TH1 and TH2 diseases coexist? Evaluation of asthma incidence in children with celiac disease, type 1 diabetes, or rheumatoid arthritis: a register study. J Allergy Clin Immunol. 2001;108(5):781–3.
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Issue | Vol 24 No 5 (2025) | |
Section | Original Article(s) | |
Keywords | ||
Allergic Asthma Atopic Celiac disease Child Dermatitis Rhinitis |
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