title: Permeability, zonulin production, and enteropathy in dermatitis herpetiformis.
abstract: OBJECTIVE
  Dermatitis herpetiformis (DH) is characterized by variable degrees of enteropathy and increased intestinal permeability. Zonulin, a regulator of tight junctions, seems to play a key role in the altered intestinal permeability that characterizes the early phase of celiac disease. Our aim was to assess both intestinal permeability and serum zonulin levels in a group of patients with DH having variable grades of enteropathy.
  
  
  METHODS
  We studied 18 DH patients diagnosed on the basis of characteristic immunoglobulin (Ig)A granular deposits in the dermal papillae of noninvolved skin. Results were compared with those of classic celiac patients, patients with linear IgA dermatosis, and healthy controls.
  
  
  RESULTS
  According to Marsh's classification, 5 patients had no evidence of enteropathy (type 0), 4 patients had type II, 2 patients had type IIIb damage, and 7 patients had a more severe lesion (type IIIc). Intestinal permeability (lactulose/mannitol ratio [lac/man]) was abnormal in all patients with DH. Patients with more severe enteropathy had significantly greater permeability ( P < .05). The serum zonulin concentration (enzyme-linked immunosorbent assay) for patients with DH was 2.1 +/- .3 ng/mg with 14 of 16 (87.5%) patients having abnormally increased values. In contrast, patients with linear IgA dermatosis had normal histology, normal intestinal permeability, and negative celiac serology.
  
  
  CONCLUSIONS
  Increased intestinal permeability and zonulin up-regulation are common and concomitant findings among patients with DH, likely involved in pathogenesis. Increased permeability can be observed even in patients with no evidence of histologic damage in biopsy specimens. Patients with linear IgA dermatosis appear to be a distinct population with no evidence of gluten sensitivity.
authors.affiliation: Dr. C. Bonorino Udaondo Gastroenterology Hospital, Av. Caseros 2061, (1264) Buenos Aires, Argentina.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Smecuol
authors.forename: Emilia
authors.initials: E
authors.lastname: Sugai
authors.forename: Sonia
authors.initials: S
authors.lastname: Niveloni
authors.forename: Horacio
authors.initials: H
authors.lastname: Vázquez
authors.forename: Silvia
authors.initials: S
authors.lastname: Pedreira
authors.forename: Roberto
authors.initials: R
authors.lastname: Mazure
authors.forename: María Laura
authors.initials: ML
authors.lastname: Moreno
authors.forename: Marcelo
authors.initials: M
authors.lastname: Label
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mauriño
authors.forename: Alessio
authors.initials: A
authors.lastname: Fasano
authors.forename: Jon
authors.initials: J
authors.lastname: Meddings
authors.forename: Julio César
authors.initials: JC
authors.lastname: Bai
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology*; D002772:Cholera Toxin / Q000096:biosynthesis* / Q000097:blood; D015897:Comorbidity; D003874:Dermatitis Herpetiformis / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006242:Haptoglobins; D006801:Humans; D015994:Incidence; D007408:Intestinal Absorption / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010539:Permeability; D011336:Probability; D011379:Prognosis; D011498:Protein Precursors; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution
chemical_list: D015415:Biomarkers; D006242:Haptoglobins; D011498:Protein Precursors; C408043:zonulin; D002772:Cholera Toxin