| Abstract | BACKGROUND: A life-long gluten-free diet is the treatment of choice for dermatitis herpetiformis, which is considered to be coeliac disease of the skin. OBJECTIVES: To investigate the effects on long-term remission of dermatitis herpetiformis in patients who underwent a gluten challenge and subsequently reintroduced dietary gluten. PATIENTS AND METHODS: We studied 38 patients (14 male and 24 female) with biopsy-confirmed dermatitis herpetiformis. They had followed a gluten-free diet for a mean of 8 years, achieving clinical remission and intestinal normalization. The patients were asked to reintroduce gluten in their diet and agreed to undergo skin and intestinal biopsies during the follow-up. RESULTS: Of the 38 patients abandoning a gluten-free diet, 31 reported the onset of rash within an average of 2 months. Seven subjects (three males, mean age 15 years at challenge) experienced no clinical or histological relapses (median follow-up 12 years), and lost IgA immunoglobulin from the skin. The two series of patients differed in terms of age at diagnosis (mean age: 26.6 vs. 6 years), the use of dapsone (one of 31 vs. four of seven) and adherence to the gluten-free diet (strict compliance in 26 of 31 vs. none of seven). CONCLUSIONS: Our data suggest that the ingestion of small doses of gluten in childhood and/or the use of an anti-inflammatory drug may modify the immunological response inducing immune tolerance. We report long-term clinical and histological remissions in seven patients with dermatitis herpetiformis after the reintroduction of dietary gluten. |
| Authors | M T Bardella, C Fredella, C Trovato, E Ermacora, R Cavalli, V Saladino, L Prampolini
(Affiliation: Cattedra di Gastroenterologia, Dipartimento di Scienze Mediche IRCCS Ospedale Maggiore, Università degli Studi di Milano, Milano, Italy. mariateresa.bardella at unimi.it)
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| Journal | The British journal of dermatology
(Br J Dermatol)
Vol. 149
Issue 5
Pg. 968-71
(Nov 2003)
ISSN: 0007-0963 England |
| PMID | 14632800
(Publication Type: Journal Article)
|
| Chemical References |
- Anti-Inflammatory Agents, Non-Steroidal
- Dapsone
- Glutens
|
| Topics |
- Adolescent
- Adult
- Age Factors
- Anti-Inflammatory Agents, Non-Steroidal
(therapeutic use)
- Child
- Child, Preschool
- Combined Modality Therapy
- Dapsone
(therapeutic use)
- Dermatitis Herpetiformis
(diet therapy, drug therapy, immunology)
- Female
- Follow-Up Studies
- Glutens
(administration & dosage, toxicity)
- Histocompatibility Testing
- Humans
- Immune Tolerance
- Male
- Middle Aged
- Patient Compliance
- Recurrence
- Remission Induction
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