Immunology Division, Department of Medical Biology, The Walter and Eliza Hall Institute, University of Melbourne, Parkville, Vic., Australia.
Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Vic., Australia.
Aliment Pharmacol Ther. 2019 Oct;50(8):901-910. doi: 10.1111/apt.15477. Epub 2019 Sep 4.
Coeliac disease patients on a gluten-free diet experience reactions to gluten, but these are not well characterised or understood. Systemic cytokine release was recently linked to reactivation of gluten immunity in coeliac disease.
To define the nature and time-course of symptoms and interleukin-2 changes specific for coeliac disease patients.
25 coeliac disease patients on a gluten-free diet and 25 healthy volunteers consumed a standardised 6 gram gluten challenge. Coeliac Disease Patient-Reported Outcome survey and global digestive symptom assessment were completed hourly up to 6 hours after gluten. Adverse events over 48 hours were recorded. Serum interleukin-2 was measured at baseline, and 2, 4 and 6 hours.
Serum interleukin-2 was always undetectable in healthy controls, whereas it was undetectable at baseline and elevated >0.5 pg/ml at 4 hours in 92% of coeliac disease patients. All patient-reported outcome severity scores increased significantly after gluten in coeliac disease patients (P < .001 Wilcoxon signed rank test), but not in controls. Symptoms began after 1 hour, and peaked in the third. Nausea and vomiting characterised severe reactions, but mild reactions were limited to headache and tiredness. Peak interleukin-2 correlated with symptom severity, particularly for nausea and vomiting.
Serum interleukin-2 elevations correlate with timing and severity of symptoms after gluten in coeliac disease. Standardised bolus gluten food challenge and interleukin-2 assessment could provide a valuable clinical test to monitor and diagnose coeliac disease in patients established on a gluten-free diet.
接受无麸质饮食的乳糜泻患者会对麸质产生反应，但这些反应的特征和机制尚未得到充分认识。最近的研究表明，系统性细胞因子释放与乳糜泻患者的麸质免疫再激活有关。
明确乳糜泻患者对麸质反应的特征和时间过程，以及白细胞介素-2（IL-2）的变化。
25 名接受无麸质饮食的乳糜泻患者和 25 名健康志愿者摄入了 6 克标准化的麸质挑战物。在摄入麸质后 6 小时内，每小时完成乳糜泻患者报告的结局量表和全球消化症状评估。记录 48 小时内的不良反应。在基线、2、4 和 6 小时测量血清 IL-2。
健康对照组的血清 IL-2始终无法检测到，而 92%的乳糜泻患者在基线时无法检测到，4 小时时升高超过 0.5pg/ml。所有乳糜泻患者的报告结局严重程度评分在摄入麸质后均显著升高（P < 0.001 配对符号秩检验），但健康对照组没有变化。症状在摄入麸质后 1 小时开始出现，并在第 3 小时达到峰值。恶心和呕吐是严重反应的特征，但轻度反应仅限于头痛和疲劳。峰值 IL-2与症状严重程度相关，尤其是与恶心和呕吐相关。
血清 IL-2升高与乳糜泻患者摄入麸质后症状的时间和严重程度相关。标准化的麸质冲击食物挑战和 IL-2评估可以为监测和诊断接受无麸质饮食的乳糜泻患者提供有价值的临床检测手段。
