title: Alcohol induces sensitization to gluten in genetically susceptible individuals: a case control study.
abstract: BACKGROUND
  The mechanisms of cerebellar degeneration attributed to prolonged and excessive alcohol intake remain unclear. Additional or even alternative causes of cerebellar degeneration are often overlooked in suspected cases of alcohol-related ataxia. The objectives of this study were two fold: (1) to investigate the prevalence of gluten-related serological markers in patients with alcohol-related ataxia and; (2) to compare the pattern of brain involvement on magnetic resonance imaging between patients with alcohol and gluten ataxias.
  
  
  METHODS
  Patients diagnosed with alcohol and gluten ataxias were identified from a retrospective review of patients attending a tertiary clinic. HLA genotype and serological markers of gluten-related disorders were recorded. Cerebellar volumetry, MR spectroscopy and voxel-based morphometric analyses were performed on patients and compared with matched control data.
  
  
  RESULTS
  Of 904 registered patients, 104 had alcohol ataxia and 159 had gluten ataxia. 61% of the alcohol ataxia group and 70% of the gluten ataxia group had HLA DQ2/DQ8 genotype compared to 30% in healthy local blood donors. 44% of patients with alcohol ataxia had antigliadin antibodies compared to 12% in the healthy local population and 10% in patients with genetically confirmed ataxias. None of the patients with alcohol ataxia and antigliadin antibodies had celiac disease compared to 40% in patients with gluten ataxia. The pattern of structural brain abnormality in patients with alcohol ataxia who had antigliadin antibodies differed from gluten ataxia and was identical to that of alcohol ataxia.
  
  
  CONCLUSIONS
  Alcohol related cerebellar degeneration may, in genetically susceptible individuals, induce sensitization to gluten. Such sensitization may result from a primary cerebellar insult, but a more systemic effect is also possible. The duration and amount of exposure to alcohol may not be the only factors responsible for the cerebellar insult.
authors.affiliation: Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Stuart
authors.initials: S
authors.lastname: Currie
authors.forename: Nigel
authors.initials: N
authors.lastname: Hoggard
authors.forename: Matthew J R
authors.initials: MJ
authors.lastname: Clark
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
authors.forename: Iain D
authors.initials: ID
authors.lastname: Wilkinson
authors.forename: Paul D
authors.initials: PD
authors.lastname: Griffiths
authors.forename: Marios
authors.initials: M
authors.lastname: Hadjivassiliou
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002524:Cerebellar Ataxia / Q000235:genetics / Q000378:metabolism; D002531:Cerebellum / Q000378:metabolism; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics*; D005983:Glutens / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000431:Ethanol; D005983:Glutens