Brahim Admou, Abir Fguirouch, Ikram Brahim, Mohamed-Reda Bouroumane, Raja Haime, Imane Brahim, Nisrine Louhab, and Najib Kissani
Context: Gluten sensitivity corresponds to a broad spectrum of clinical manifestations including celiac disease and non-enteropathic based disorders. Among the latter conditions, neurologic disorders of unknown etiology seem frequently associated to anti-gliadin antibodies (AGA), usually called gluten neuropathies.
Objectives: We aimed to determine the clinical significance of AGA in neurologic diseases of unknown etiology.
Patients and Methods: We prospectively enrolled 60 patients with following conditions: peripheral neuropathy (n=16), Ischemic Stroke (n=18), ataxia (n=7), epilepsy (n=7), myopathy (n=3), Myelopathy (n=2), Multiple Sclerosis (n=1), Thrombophlebitis (n=1) and undefined clinical conditions (n=5), matched to 57 healthy controls. Patients and controls underwent a screening for IgG and IgA AGA using an immunoenzymatic method (ELISA-Gliadin, Orgentec®, threshold: 12IU/ml). In order to rule out an authentic celiac disease, IgA anti-tissue transglutaminase antibodies (tTGA) were performed in both patients and controls, using an ELISA method (DRG®, IgA-tTGA, Inc. USA, threshold: 10 IU/ml).
Results: The mean age of the patients was 43 ± 13.91 years (ranges: 13-67), versus 39.4 ± 9.12 (ranges: 19-58) for controls. Male to female sex-ratio was 0.7 for patients versus 2.1 for controls. IgG and/or IgA AGA were positive in 26.7% of cases (n=16) vs 15.8% (n=9) in controls, while IgA-tTGA was negative in all patients, but positive in one case among controls. Positive AGA cases corresponded to peripheral neuropathy (n=4), ataxia (n=3), ischemic stroke (n=3), myopathy (n=2), and one case for each of the following conditions: multiple sclerosis, epilepsy, cerebral thrombophlebitis and myelopathy. Among the positive AGA cases, IgA isotype was more prevalent, but IgG AGA titers were higher and clinically more relevant.
Conclusion: Our data give evidence that Gluten Sensitivity represents a potential cause of idiopathic neurologic diseases in young adults, particularly peripheral neuropathy, ataxia and ischemic stroke, and lesser in myopathy. AGA testing might be a suitable marker to screen for gluten neuropathies provided ruling out an atypical celiac disease. Further studies on bigger sample size are recommended, using additional relevant markers of gluten neurologic disorders.
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