Excerpted from the Autumn 2007 issue of Allergy Today. For more articles like this, subscribe to Allergy Today, click here.

coeliac disease and the vaccine quest

Quite a few people choose to adopt a gluten-free diet to try and eliminate symptoms of food intolerance, but for people with coeliac disease, eating gluten free is not a choice but a necessity. About 1 per cent of the population are affected, although researchers believe is the disease is under-diagnosed and much more prevalent. There is hope on the horizon, with the possibility of a vaccine inducing tolerance to gluten.

Up until now, the only treatment for coeliac disease has been to follow an expensive, time-consuming and inconvenient gluten-free diet.

But going gluten-free could become a thing of the past if a group of Australian scientists are successful with the development of a highly specific peptide immunotherapy (vaccine) to induce tolerance to gluten.

“What peptide therapy is doing is producing a stronger regulatory T-Cell that will replace a gluten-free diet,” says Dr Robert Anderson, a gastroenterologist and founder of Nexpep, the company researching the vaccine.

Dr Anderson is a recognised world leader in coeliac disease research, and began working in this area in 1998 at Oxford University where he discovered the peptide in wheat that elicits a specific immune response in people with coeliac disease.
“This is the first human disease of this type where we can design peptides for the particular disease. The research is promising, and we will be starting Phase I trials in Melbourne next year,” he told Allergy Today.

This general approach has been highly successful in non-human models of immune diseases and in people with cat-sensitive asthma. It is also under active investigation for Type 1 diabetes, multiple sclerosis and rheumatoid arthritis.

Coeliac disease is a life-long immune intolerance to specific components of wheat, rye, barley and oat gluten proteins. This intolerance leads to damage of the lining of the gut, which can cause malabsorption and malnutrition.

The small intestine is normally lined by special structures called villi, which enhance the absorption of nutrients. In a person with coeliac disease, there is complete or partial loss of the villi, which results in poor absorption of nutrients and the loss of some digestive enzymes.
The severity and the nature of symptoms varies widely and may include diarrhoea/constipation, abdominal pain, flatulence, dermatitis herpetiformis and changes associated with vitamin/mineral deficiencies such as fatigue, anaemia and weight loss. When gluten is excluded from the diet, the villi regrow and digestion resumes in a normal manner.

If it’s left untreated, it can have serious consequences, including lack of proper development, short stature and behavioural problems in children.

“It can cause recurrent miscarriages, osteoporosis, Type I diabetes, an increased risk of gastrointestinal cancers and unexplained liver disease,” Dr Anderson pointed out.
“In one study, they found that one in 20 people waiting for a liver transplant had undiagnosed coeliac disease.”

The only reliable test for coeliac disease is an intestinal biopsy that is done while you eat a normal amount of gluten, although blood tests can be useful as screening tests. Meanwhile, there is hope that peptide immunotherapy can lead to the long-term control of coeliac disease.

If you suffer from coeliac disease or wish to obtain more information about gluten intolerance, please contact the Coeliac Society of New Zealand.
Phone 09 820 5157 24 Hour Answer-phone
Email coeliac@xtra.co.nz
Website www.coeliac.co.nz

About Dr Anderson

In 2002, Dr Anderson established a dedicated coeliac disease research group and clinic based at The Walter and Eliza Hall Institute (WEHI) and The Royal Melbourne Hospital. He is the author of many published articles, and lectures extensively around the world.

What are the symptoms?

Around 10 per cent of all first degree relatives (parents, brothers, sisters or children) of known coeliacs also have the disease.

Most common symptoms in adults

• Diarrhoea - This may begin at any age and is often present for years prior to diagnosis. It may first appear after other illnesses (such as gastroenteritis) or abdominal operations.
• Fatigue, weakness and lethargy
• Anaemia - iron or folic acid deficiency are the most common. The anaemia will either not respond to treatment or will recur after treatment until the correct diagnosis is made and a gluten free diet is begun.
• Weight loss.
• Constipation- some people are more likely to experience constipation than diarrhoea.
• Flatulence and abdominal distention.
• Cramping and bloating.
• Nausea and vomiting.

Less common

• Easy bruising of the skin
• Ulcerations and/or swelling of mouth and tongue
• Miscarriages and infertility
• Low blood calcium levels with muscle spasms
• B12, A, D, E and K vitamin deficiency
• Skin rashes such as Dermatitis Herpetiformis
• Altered mental alertness
• Bone and joint pains

Common in children

Symptoms do not occur until gluten is introduced into an infant's diet - later onset is also possible.
• Large, bulky, foul stools
• Diarrhoea or constipation
• Poor weight gain
• Weight loss in older children
• Chronic anaemia
• Retarded growth
• Abdominal distention, pain and flatulence
• Nausea and vomiting
• Irritability

Source: Coeliac Society of New Zealand