CELIAC DISEASE can be treated with IMMUNOTHERAPY (Novel Treatment)

CELIAC DISEASE and WHEAT ALLERGY can be treated with IMMUNOTHERAPY (Novel Treatment)
• Celiac Disease is an AUTOIMMUNE DISEASE while Wheat allergy is IMMUNE.DISEASE. Both are triggered with WHEAT, and both are genetically transmitted.
• People with celiac disease often make antibodies Anti Tissue Transglutaminase Antibodies (IgG IgA), Causing intestinal damage or VILLOUS ATROPY
• Celiac disease is diagnosed in only 30% while 70% remain undiagnosed and suffer complications due to non-treatment.
• It is sad that there is no Available therapy for Celiac Disease and patients have to eat a strict gluten-free diet.
• A better understanding of Immunology has paved the way to alternative therapies, restoring a physiological immune response to gluten ingestion.
• Wheat Allergy and Coeliac Disease generally coexist in the same person and immunotherapy improve both celiac disease and wheat allergy.
• WHEAT has 4 major proteins like ALBUMINS, GLOBULINS, PROLAMINS, and GLUTEN. Celiac Disease is caused by Gluten while wheat allergy is caused by Gliadin in wheat.
• The GRAINS containing GLUTEN are WHEAT, BARLEY, RYE, and SPELT and these are avoided in Celiac Disease. The grains recommended in such patients are CORN, OATS, RICE, MILLET, AMARANTH, BUCKWHEAT, and QUINOA.
• SYMPTOMS of CELIAC DISEASE
• Diarrhea, gas passing, bloating, vomiting, constipation, constipation alternating with diarrhea, nausea, and malabsorption.
• Extraintestinal symptoms are skin irritation, weight loss, anemia, chronic fatigue, weakness, muscle cramps, neurological complaints (including seizures), and possibly migraine headaches, concentration, and memory problems. ADHD, Autism, muscular and bone, and joint pains. The child is anemic and has retarded growth
Wheat IMMUNOTHERAPY for CELIAC DISEASE
• SLIT is Prepared according to SPT results for Wheat and other foods.
• Allergen extracts have immuno-reactive peptides recognized by HLA-DQ2.5, expressed on dendritic cells & by the TCR of CD4+T-cells & increased production of IL-10 (Anti-inflammatory).
• Treg Cells - Inactivation of pathogenic T-cells reactive to the disease-relevant gluten peptides after SLIT administration
• Repeated exposure to SLIT is thought to restore a normal tolerance toward gluten, thus healing deranged small bowel mucosa of patients with Celiac disease.

OUR PROJECT
• 10 patients with age range of 4 yrs to 27 yrs.
• 50% diagnosed by endoscopy and biopsy 90% IgA & IgG Anti Tissue Transglutaminase Ab
• 80-90% had increased IgE levels by more than 100IU/ml
• All had variable symptoms Symptoms

• SPT for 8 FOODS (wheat, milk, corn, Egg, Soya, , Yeast, Peanuts, Lentils).
• SPT for AERO16 most commonly found aeroallergens in Pollens, molds, Dust
• All were skin tested positive for Aero allergens and multiple foods and wheat were positive in all patients.
• Recommended SLIT for food and aeroallergens
• Stopped wheat and relevant foods as per results of skin tests for 4 months.
• Reversal of Anti Tissue Transglutaminase Antibodies (Anti-tTg IgA) and IgG in 6 months in 80%
• After 4 months FOOD CHALLENGE TESTS: The patient was allowed to take wheat for one day and avoid other foods to which the patient was spt positive. Parents were informed to observe the symptoms and inform us. If there are symptoms, then again the patient was asked to stop WHEAT for another 2 months and repeat the food challenge test
• 50% improved in first 4-6 months and 90% in 1 year in symptoms, gained weight, height.

NEXVAX2 first Trial in the world was done by a multicenter study Group in 2019.
• Efficacy of epitope-based immunotherapy (Injectable) has been demonstrated by NEXVAX2 in New Zeland, Australia & USA
• We have demonstrated efficacy with whole wheat extract immunotherapy (SLIT) in the limited Observational study with 10 patients and hope a bigger study may be conducted

Dr. Shahid Abbas
• Consultant Allergy & Immunology
• FAAAAI (Fellow American Academy Allergy Asthma and Immunology.
• MBBS, MSc (Med. Immunology-UK), DCP,
• DPCF (Diploma Personal Care Formulation-Australia)
• President PAAIS (Pakistan Allergy Asthma and Immunology Society)

• Find Us At,  facebook.com/allergyclinicislamabad, @allergycentre, allergy centre tv
EMAIL:-
[email protected], [email protected]
WEBSITES
www.allergycenter.info, www.allergypaais.org. www.drshahidskincare.com
https://www.westminsterclinic.ae/our-doctors/dr-shahid-abbas/
https://www.americanwellnesscenter.ae/doctor/profile/53/Dr--Shahid-Abbas
CLINICS DUBAI AND PAKISTAN
1- Westminster Ortho Med Clinic, Block A, room 203, Ibn Sina building 27, Dubai Health Care City +971 4 276 5606, Whatsapp+971 55 267 7405

2- American Wellness Center FZ-LLC, AL Faris Building. 39, Ground Floor, Dubai Healthcare City, Dubai, +971 4 818 4900, +971 4 514 4042

3- Allergy and Asthma Center, Al Rehman Chambers, Fazal e Haque Road, Blue Area, Islamabad. +92 51 111 160160