title: [Atypical celiac disease--diagnostic difficulties].
abstract: In predisposed individuals dietary intake of cereal products may lead to the development of food allergy or celiac disease. These diseases may also coexist with each other. In recent years, a change in the clinical picture of celiac disease has been observed and the incidence of atypical forms has increased. The disease is currently either diagnosed late or often remains undiagnosed. The article presents a case of an underweight 11- year old girl with height deficiency and recurrent respiratory infections, as well as chronic rhinitis, occurring from the age of three. On the basis of complex differential diagnosis, sensitization to tree pollens, and to cow's milk protein and gluten were identified. Despite the detection of antibodies specific for celiac disease, such as the antibodies against smooth muscle endomysium (IgAEMA) and anti-tissue transglutaminase antibodies (IgAtTGAb), the histological confirmation of the diagnosis was not obtained. Implementation of the gluten and milk protein-free - elimination diet and the use of antihistamines resulted in clinical improvement and the disappearance of markers of both food sensitization and celiac disease. The second food provocation test was negative for previously detected markers of food sensitization but showed the presence of IgAEMA and IgAtTGAb and the histological features of intestinal mucosa typical for celiac disease.
  
  
  CONCLUSIONS
  The diagnosis of food allergy or other chronic diseases which can cause growth disturbance (short stature and/or impaired weight gain ) should not exempt from the obligation of estimating the markers specific for celiac disease.
authors.affiliation: Zakład Żywienia, Instytut Matki i Dziecka, ul. Kasprzaka 17A, 01-211 Warszawa, Poland. growicka@gmail.com
authors.forename: Grażyna
authors.initials: G
authors.lastname: Rowicka
mesh_terms: D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003937:Diagnosis, Differential; D055050:Diet, Gluten-Free; D005260:Female; D006130:Growth Disorders / Q000150:complications; D006801:Humans; D016269:Milk Hypersensitivity / Q000150:complications* / Q000175:diagnosis* / Q000517:prevention & control; D041941:Milk Substitutes / Q000008:administration & dosage; D012220:Rhinitis / Q000150:complications