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Objectives: An increased frequency of celiac disease (CeD) has been reported in severe Immunoglobulin E (IgE) -mediated food allergy (FA). This observation requires confirmation, and whether CeD affects FA severity and resolution is unknown. The study aims to estimate the prevalence of CeD in patients with FA and to investigate whether CeD affects FA severity and oral tolerance. Methods: Consecutive patients with FA referred for allergen reintroduction, either to evaluate allergy resolution or to start oral immunotherapy (OIT), were evaluated for CeD and for FA severity. The primary outcome was the prevalence of CeD. Secondary outcomes were the frequency of severe FA and the level of clinical tolerance at study entry and at last follow-up in patients with isolated FA versus patients with FA + CeD. Results: Two hundred twenty-eight patients were included. CeD was confirmed in 15 patients (6.6%) of whom, 8 patients had a previously established diagnosis of CeD and were on a gluten-free diet. Severe FA was observed in 12 patients with FA + CeD (80%) versus 88 patients with FA (42%) ( P = 0.006). At baseline, patients with FA + CeD had significantly higher median allergen-specific IgE levels [61.8 kU/L; interquartile range (IQR) 11.6-279.0] compared to patients with FA (20.3 kU/L; IQR 2.9-72.7) ( P < 0.001). Complete clinical tolerance was observed in 1 of 15 patients (7%) with FA + CeD versus 98 of 205 patients (48%) with FA ( P = 0.002). Conclusions: CeD is highly prevalent in patients with FA and could affect FA severity and response to OIT. CeD screening should be considered in patients with severe or persistent FA.

The serum anti-transglutaminase antibodies are the immunological markers for coeliac disease diagnosis. These autoantibodies are synthesized by B-lymphocytes at the intestinal level and their presence in the form of intestinal deposits is a constant feature in the different clinical entities in which coeliac disease is classified: classical, silent, and potential. These intestinal autoantibodies are the first gluten dependent inflammatory markers and they appear before both the intestinal damage and the serum anti-transglutaminase antibodies. The anti-transglutaminase deposits should be looked for to confirm or exclude the diagnosis of coeliac disease when the clinical and immunological features are incomplete or in asymptomatic at risk patients.

At the Immunopathology Laboratory at the IRCCS Burlo Garofolo hospital the research activity is based on autoimmune diseases, above all on celiac disease in order to diagnose it in an early stage. For this reason, we are collecting many serum samples and intestinal biopsies to analyse them with molecular (phage-display) and immunofluorescent (double staining and activated beads) assays. Within the Trans2Care project we intend to apply these methods in several areas related to the problems explored by the Project partners with the aim of promote collaboration, mobility of researchers and exchange of knowledge between partners.

Genetic gluten intolerance is a multifactorial condition characterized by the intestinal synthesis of antitransglutaminase antibodies (anti-tTG) which might represent an early stage of this intolerance in absence of both intestinal damage and serum anti-tTG. The double immunofluorescence staining (IF) is able to point out these anti-tTG antibodies directly on intestinal biopsy. Her we describe a prospective study in which patients were analysed for genetic predisposition (HLA DQ2-DQ8) and serum anti-tTG and were monitored for clinical conditions and serum anti-tTG concentration during gluten free diet (GFD) or gluten containing diet (GCD). Our results demonstrate that the measurement of intestinal anti-tTG is a useful screening procedure to identify patients with genetic predisposition not fullfilling the current diagnostic criteria.

2009/2010 La permeabilità intestinale è regolata dalle tight junctions (TJ) che costituiscono la barriera gastrointestinale e che sono soggette a regolazione fisiologica. Dati di letteratura dimostrano che digiuno e malnutrizione agiscono su tale barriera alterando la morfologia dell’epitelio intestinale e aumentando il movimento degli ioni e delle grandi molecole attraverso la via paracellulare. Partendo da queste osservazioni abbiamo ipotizzato che il digiuno potesse avere un ruolo nella modulazione delle TJ e siamo andati a valutare in vivo gli effetti del digiuno sull’assorbimento orale della tobramicina e sulla permeabilità della via paracellulare. Con questo studio abbiamo dimostrato per la prima volta che la biodisponibilità della tobramicina dipende dalla condizione fisiologica. L’assorbimento orale del farmaco è, infatti, aumentato in maniera significativa quando gli animali sono tenuti a digiuno per 15 ore. XXIII Ciclo

Background Recently published paediatric guidelines for diagnosing coeliac disease do not include recommendations on the follow-up of coeliac disease patients. Goal The aim of this study was to assess the management practices and experience of coeliac disease patients with their follow-up appointments in Central Europe. Study Gastroenterologists and coeliac disease patients in five Central European countries were asked to complete the web-based questionnaire focusing on coeliac disease management practices. Results Answers from 147 gastroenterologists and 2041 coeliac disease patients were available for the analysis. More than half of the gastroenterologists (58.5%) schedule the first follow-up visit within 3 months after the diagnosis. At follow-up, tissue transglutaminase antibodies are checked in almost all patients (95.9%). Approximately two-thirds (60.7%) of gastroenterologists refer all of their patients to the dietitian at diagnosis. Similarly, 42.8% of coeliac disease patients reported that they had not been appointed to a dietitian. Almost one-third of coeliac disease patients (30.8%) reported that they had no follow-up appointments with gastroenterologist at all. Conclusions Follow-up of coeliac disease patients is suboptimal in Central Europe. Many patients are not followed regularly. A lot of patients are not referred to a dietitian. The recommendations on the optimal follow-up of coeliac disease patients are needed in order to improve patient care.