Gluten intake interferes with the humoral immune response to recombinant hepatitis B vaccine in patients with celiac disease.
OBJECTIVE
Patients with celiac disease, who often carry human leukocyte antigen-DR3;DQ2, are prone to inadequate response to hepatitis B immunization. We evaluated vaccine response in relation to disease activity and whether previous treatment with a gluten-free diet influences the achievement of protective antibody titers.


METHODS
We studied 128 children and adolescents with celiac disease and 113 age-matched control subjects. Twenty-two patients with celiac disease were prospectively immunized after diagnosis during dietary treatment (group 1). A total of 106 (group 2) and the control subjects received vaccination by mass immunization in schools at 14 years of age regardless of diet status and when celiac disease was still undiagnosed in 27 of these children. Diet compliance and celiac disease activity were monitored by measurement of antibodies against transglutaminase and endomysium. Vaccine response was determined by measuring antihepatitis B antibodies from serum.


RESULTS
The seroconversion after hepatitis B vaccination was 95.5% in group 1. All of these patients carried human leukocyte antigen DQ2. The response rate in group 2 was 50.9% and correlated with gluten intake (untreated patients: 25.9%, non-strict diet: 44.4%, strict diet: 61.4%). Treated and compliant patients did not significantly differ from control subjects (75.2%). Thirty-seven antihepatitis B-negative patients with celiac disease received a booster during a controlled gluten-free diet, and 36 (97.3%) seroconverted, irrespective of the presence of human leukocyte antigen DQ2.


CONCLUSIONS
Nonresponse to recombinant hepatitis B surface antigen may be a sign of undiagnosed celiac disease. However, there is a good vaccine response in adequately treated patients. Human leukocyte antigen DQ alleles do not seem to have a primary role. Revaccination is recommended during a controlled gluten-free diet.
Department of Pediatrics, Medical and Health Science Center, University of Debrecen, Nagyerdei krt 98, H-4032 Debrecen, Hungary. enemes@dote.hu
Eva
E
Nemes
Eva
E
Lefler
László
L
Szegedi
Anikó
A
Kapitány
Judit B
JB
Kovács
Márta
M
Balogh
Katalin
K
Szabados
Judit
J
Tumpek
Sándor
S
Sipka
Ilma R
IR
Korponay-Szabó
D016022:Case-Control Studies; D002446:Celiac Disease / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005983:Glutens / Q000008:administration & dosage / Q000009:adverse effects*; D006514:Hepatitis B Surface Antigens / Q000096:biosynthesis*; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006801:Humans; D008297:Male; D014614:Vaccines, Synthetic / Q000276:immunology*
C075654:Engerix-B; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic; D005983:Glutens