Neuropathy associated with gluten sensitivity.
OBJECTIVE
To prospectively study the clinical, neurophysiological and neuropathological characteristics of axonal neuropathies associated with positive antigliadin antibodies and the prevalence of such neuropathies in a cohort of patients with sporadic axonal neuropathy.


METHODS
Prospective screening (using antigliadin, antiendomysium and tissue transglutaminase antibodies) of patients with peripheral neuropathy attending a neurology clinic.


RESULTS
215 patients with axonal neuropathy were screened. 141 patients had symmetrical sensorimotor neuropathy, 47 had mononeuropathy multiplex, 17 had motor neuropathy and 10 had small-fibre neuropathy. Despite extensive investigations of the 215 patients, 140 had idiopathic neuropathy. Positive immunoglobulin (Ig)G with or without IgA antigliadin antibodies was found in 34% (47/140) of the patients with idiopathic neuropathy. This compares with 12% prevalence of these antibodies in the healthy controls. The prevalence of coeliac disease as shown by biopsy in the idiopathic group was at least 9% as compared with 1% in the controls. The clinical features of 100 patients (47 from the prevalence study and 53 referred from elsewhere) with gluten neuropathy included a mean age at onset of 55 (range 24-77) years and a mean duration of neuropathy of 9 (range 1-33) years. Gluten-sensitive enteropathy was present in 29% of patients. The human leucocyte antigen types associated with coeliac disease were found in 80% of patients.


CONCLUSIONS
Gluten sensitivity may be aetiologically linked to a substantial number of idiopathic axonal neuropathies.
Hadjivassiliou
M
M
Department of Neurology, The Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. m.hadjivassiliou@sheffield.ac.uk
Grünewald
R A
RA
Kandler
R H
RH
Chattopadhyay
A K
AK
Jarratt
J A
JA
Sanders
D S
DS
Sharrack
B
B
Wharton
S B
SB
Davies-Jones
G A B
GA
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D016022:Case-Control Studies; D002446:Celiac Disease / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005983:Glutens / Q000009:adverse effects* / Q000276:immunology; D006680:HLA Antigens / Q000032:analysis; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007223:Infant; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000276:immunology*; D015995:Prevalence; D011446:Prospective Studies
D006680:HLA Antigens; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005983:Glutens