Gluten challenge induces skin and small bowel relapse in long-term gluten-free diet-treated dermatitis herpetiformis

E. Mansikka, K. Hervonen, K. Kaukinen, T. Ilus, P. Oksanen, K. Lindfors, K. Laurila, M. Hietikko, J. Taavela, J. Jernman, P. Saavalainen, T. Reunala, T. Salmi

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Dermatitis herpetiformis (DH) is an extra-intestinal manifestation of coeliac disease causing an itchy, blistering rash. Skin IgA deposits are pathognomonic for DH, and the treatment of choice is a life-long gluten-free diet (GFD). Preliminary evidence suggests that there are DH patients who redevelop gluten tolerance after adherence to a GFD treatment. To examine this, we performed a 12-month gluten challenge with skin and small bowel mucosal biopsies in 19 DH patients who had adhered to a GFD for a mean of 23 years. Pre-challenge biopsies showed negative skin IgA and transglutaminase 3 deposits in 16 (84%) patients and normal villous height crypt depth ratios in the small bowel mucosa in all 19 patients. The gluten challenge caused a relapse of the rash in 15 (79%) patients in a mean of 5.6 months; 13 of these patients had skin IgA and transglutaminase 3 deposits, and 12 had small bowel villous atrophy. In addition, three patients without rash or skin immune deposits developed villous atrophy, while one patient persisted without any signs of relapse. In conclusion, 95% of the DH patients were unable to tolerate gluten even after long-term adherence to a GFD. Therefore, life-long GFD treatment remains justified in all DH patients.
Original languageEnglish
JournalJournal of Investigative Dermatology
ISSN0022-202X
DOIs
Publication statusPublished - 15 Apr 2019
MoE publication typeA1 Journal article-refereed

Cite this

@article{238ba82ec8e44bcd881993df3a86e8b1,
title = "Gluten challenge induces skin and small bowel relapse in long-term gluten-free diet-treated dermatitis herpetiformis",
abstract = "Dermatitis herpetiformis (DH) is an extra-intestinal manifestation of coeliac disease causing an itchy, blistering rash. Skin IgA deposits are pathognomonic for DH, and the treatment of choice is a life-long gluten-free diet (GFD). Preliminary evidence suggests that there are DH patients who redevelop gluten tolerance after adherence to a GFD treatment. To examine this, we performed a 12-month gluten challenge with skin and small bowel mucosal biopsies in 19 DH patients who had adhered to a GFD for a mean of 23 years. Pre-challenge biopsies showed negative skin IgA and transglutaminase 3 deposits in 16 (84{\%}) patients and normal villous height crypt depth ratios in the small bowel mucosa in all 19 patients. The gluten challenge caused a relapse of the rash in 15 (79{\%}) patients in a mean of 5.6 months; 13 of these patients had skin IgA and transglutaminase 3 deposits, and 12 had small bowel villous atrophy. In addition, three patients without rash or skin immune deposits developed villous atrophy, while one patient persisted without any signs of relapse. In conclusion, 95{\%} of the DH patients were unable to tolerate gluten even after long-term adherence to a GFD. Therefore, life-long GFD treatment remains justified in all DH patients.",
author = "E. Mansikka and K. Hervonen and K. Kaukinen and T. Ilus and P. Oksanen and K. Lindfors and K. Laurila and M. Hietikko and J. Taavela and J. Jernman and P. Saavalainen and T. Reunala and T. Salmi",
year = "2019",
month = "4",
day = "15",
doi = "10.1016/j.jid.2019.03.1150",
language = "English",
journal = "Journal of Investigative Dermatology",
issn = "0022-202X",
publisher = "EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC",

}

Gluten challenge induces skin and small bowel relapse in long-term gluten-free diet-treated dermatitis herpetiformis. / Mansikka, E.; Hervonen, K.; Kaukinen, K.; Ilus, T.; Oksanen, P.; Lindfors, K.; Laurila, K.; Hietikko, M.; Taavela, J.; Jernman, J.; Saavalainen, P.; Reunala, T.; Salmi, T.

In: Journal of Investigative Dermatology, 15.04.2019.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Gluten challenge induces skin and small bowel relapse in long-term gluten-free diet-treated dermatitis herpetiformis

AU - Mansikka, E.

AU - Hervonen, K.

AU - Kaukinen, K.

AU - Ilus, T.

AU - Oksanen, P.

AU - Lindfors, K.

AU - Laurila, K.

AU - Hietikko, M.

AU - Taavela, J.

AU - Jernman, J.

AU - Saavalainen, P.

AU - Reunala, T.

AU - Salmi, T.

PY - 2019/4/15

Y1 - 2019/4/15

N2 - Dermatitis herpetiformis (DH) is an extra-intestinal manifestation of coeliac disease causing an itchy, blistering rash. Skin IgA deposits are pathognomonic for DH, and the treatment of choice is a life-long gluten-free diet (GFD). Preliminary evidence suggests that there are DH patients who redevelop gluten tolerance after adherence to a GFD treatment. To examine this, we performed a 12-month gluten challenge with skin and small bowel mucosal biopsies in 19 DH patients who had adhered to a GFD for a mean of 23 years. Pre-challenge biopsies showed negative skin IgA and transglutaminase 3 deposits in 16 (84%) patients and normal villous height crypt depth ratios in the small bowel mucosa in all 19 patients. The gluten challenge caused a relapse of the rash in 15 (79%) patients in a mean of 5.6 months; 13 of these patients had skin IgA and transglutaminase 3 deposits, and 12 had small bowel villous atrophy. In addition, three patients without rash or skin immune deposits developed villous atrophy, while one patient persisted without any signs of relapse. In conclusion, 95% of the DH patients were unable to tolerate gluten even after long-term adherence to a GFD. Therefore, life-long GFD treatment remains justified in all DH patients.

AB - Dermatitis herpetiformis (DH) is an extra-intestinal manifestation of coeliac disease causing an itchy, blistering rash. Skin IgA deposits are pathognomonic for DH, and the treatment of choice is a life-long gluten-free diet (GFD). Preliminary evidence suggests that there are DH patients who redevelop gluten tolerance after adherence to a GFD treatment. To examine this, we performed a 12-month gluten challenge with skin and small bowel mucosal biopsies in 19 DH patients who had adhered to a GFD for a mean of 23 years. Pre-challenge biopsies showed negative skin IgA and transglutaminase 3 deposits in 16 (84%) patients and normal villous height crypt depth ratios in the small bowel mucosa in all 19 patients. The gluten challenge caused a relapse of the rash in 15 (79%) patients in a mean of 5.6 months; 13 of these patients had skin IgA and transglutaminase 3 deposits, and 12 had small bowel villous atrophy. In addition, three patients without rash or skin immune deposits developed villous atrophy, while one patient persisted without any signs of relapse. In conclusion, 95% of the DH patients were unable to tolerate gluten even after long-term adherence to a GFD. Therefore, life-long GFD treatment remains justified in all DH patients.

U2 - 10.1016/j.jid.2019.03.1150

DO - 10.1016/j.jid.2019.03.1150

M3 - Article

JO - Journal of Investigative Dermatology

JF - Journal of Investigative Dermatology

SN - 0022-202X

ER -