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PEDIATRICS Vol. 113 No. 5 May 2004, pp. e418-e422

ELECTRONIC ARTICLE

The Temporal Relationship Between the Onset of Type 1 Diabetes and Celiac Disease: A Study Based on Immunoglobulin A Antitransglutaminase Screening

Noel Peretti, MD*, Françoise Bienvenu, MD*, Charlotte Bouvet, MD*, Nicole Fabien, MD{ddagger}, Frédérique Tixier, MD*, Charles Thivolet, MD, PhD§, Emile Levy, MDPhD||, Pierre G. Chatelain, MD, PhD*, Alain Lachaux, MD, PhD and Marc Nicolino, MD, PhD*

* Hôpital Debrousse, Département d’endocrinologie pédiatrique, Lyon, France
{ddagger} Hôpital Lyon Sud, Service Immunologie, Pierre Bénite, France
§ Hôpital Edouard Herriot, Service Endocrinologie Pav X, Lyon, France
|| Centre de Recherche, Hôpital Ste Justine, Montréal, Québec, Canada
Hôpital Edouard Herriot, Service Gastroentérologie Pav S, Lyon, France

Objective. The association of celiac disease (CD) and type 1 diabetes is now clearly documented. Immunoglobulin A (IgA) antitransglutaminase antibodies were measured to determine the prevalence of celiac disease in a diabetic population of children and to determine the temporal relationship between type 1 diabetes onset and CD.

Methods. We measured IgA antitransglutaminase antibodies using human recombinant antigen in parallel with classical markers (IgA and IgG antigliadin, IgA antiendomysium) in 284 children with diabetes.

Results. In the population studied, the prevalence of CD was 3.9% (11 of 284). Two cases of CD were diagnosed before the onset of diabetes, and in 8 patients, the diagnoses of CD and diabetes were concomitant, suggesting that CD was present before the onset of diabetes. In 1 case, a girl who presented with thyroiditis, serology for CD became positive after diabetes had been diagnosed.

Conclusion. An excellent correlation was observed between IgA antiendomysium and IgA antitransglutaminase antibodies. We therefore propose using IgA antitransglutaminase as a screening test for practical reasons. Furthermore, IgA antitransglutaminase levels and mucosa abnormalities were closely correlated. The presence of antitransglutaminase antibodies should alert pediatricians to the atypical forms of CD. This study indicates that CD is most often present before the onset of diabetes.

Key Words: celiac disease • type 1 diabetes • children • screening test • anti-transglutaminase autoantibodies • prevalence • autoimmune diseases

Abbreviations: CD, celiac disease • tTG, transglutaminase • Ig, immunoglobulin • AGA, antigliadin antibodies • EMA, endomysium antibodies • AU, arbitrary units • GFD, gluten-free diet

Received for publication Jul 28, 2003; Accepted Dec 29, 2003.


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