title: High rate of spontaneous normalization of celiac serology in a cohort of 446 children with type 1 diabetes: a prospective study.
abstract: OBJECTIVE
  In children with type 1 diabetes mellitus (T1DM), elevated levels of antitissue transglutaminase (anti-tTG) antibody may spontaneously normalize, despite continued consumption of gluten. We aimed to investigate the prevalence of spontaneous normalization of anti-tTG levels and the existence of factors predictive for this outcome.
  
  
  METHODS
  All children referred from 2002 to 2012 were screened for celiac disease (CD) at diabetes onset and at specific intervals. In the presence of a high anti-tTG titer or clinical symptoms, children were offered endoscopy, and asymptomatic patients with a low anti-tTG titer were invited to a second serological test after 6 months of eating a gluten-containing diet.
  
  
  RESULTS
  The study included 446 children. Of these, 65 (14.5%) became positive for celiac serology: 38 (58%) had a persistently elevated anti-tTG titer and 27 (41%) fluctuating anti-tTG titer; 18 (28%) became negative. The prevalence of positive CD autoimmunity and overt CD was 14.3% (95% CI 11-17) and 8.5% (95% CI 5-10), 15- and 8-times higher than the general pediatric population, respectively. Asymptomatic children older than 9.1 years at T1DM onset had the lowest risk to develop CD.
  
  
  CONCLUSIONS
  Serum anti-tTG levels decreased spontaneously in 40% of children with T1DM and became negative in 20%, despite gluten consumption. This finding supports the hypothesis of a state of temporary positivity of celiac serology in children with diabetes. In absence of clinical symptoms or signs of CD, histological confirmation of the disease and the gluten-free diet should be postponed to avoid unnecessary procedures and reduce an additional psychological burden.
authors.affiliation: Department of Pediatrics, San Paolo Hospital, Bari, Italy scastellaneta@libero.it.
authors.forename: Stefania
authors.initials: S
authors.lastname: Castellaneta
authors.affiliation: Unit of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXII Children's Hospital, Bari, Italy.
authors.forename: Elvira
authors.initials: E
authors.lastname: Piccinno
authors.affiliation: Pediatric Gastroenterology and Hepatology Unit, Interdisciplinary Department of Medicine, Giovanni XXII Children's Hospital, University of Bari "A. Moro," Bari, Italy.
authors.forename: Marica
authors.initials: M
authors.lastname: Oliva
authors.affiliation: Pediatric Gastroenterology and Hepatology Unit, Interdisciplinary Department of Medicine, Giovanni XXII Children's Hospital, University of Bari "A. Moro," Bari, Italy.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Cristofori
authors.affiliation: Unit of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXII Children's Hospital, Bari, Italy.
authors.forename: Marcella
authors.initials: M
authors.lastname: Vendemiale
authors.affiliation: Unit of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXII Children's Hospital, Bari, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Ortolani
authors.affiliation: Unit of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXII Children's Hospital, Bari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Papadia
authors.affiliation: Department of Paediatrics, University Politecnica delle Marche, Ancona, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catassi
authors.affiliation: Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro," Bari, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Cavallo
authors.affiliation: Pediatric Gastroenterology and Hepatology Unit, Interdisciplinary Department of Medicine, Giovanni XXII Children's Hospital, University of Bari "A. Moro," Bari, Italy.
authors.forename: Ruggiero
authors.initials: R
authors.lastname: Francavilla
mesh_terms: D000704:Analysis of Variance; D001323:Autoantibodies / Q000378:metabolism*; D015551:Autoimmunity / Q000276:immunology*; D002446:Celiac Disease / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000276:immunology*; D055050:Diet, Gluten-Free; D005260:Female; D019204:GTP-Binding Proteins / Q000378:metabolism*; D005983:Glutens / Q000008:administration & dosage / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000378:metabolism; D008297:Male; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012307:Risk Factors; D011503:Transglutaminases / Q000378:metabolism*
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D005983:Glutens; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins