How to manage celiac disease and gluten-free diet during the COVID-19 era: proposals from a tertiary referral center in
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How to manage celiac disease and gluten‑free diet during the COVID‑19 era: proposals from a tertiary referral center in a high‑incidence scenario Luca Elli1,2* , Donatella Barisani3, Valentina Vaira2,4, Maria Teresa Bardella1, Matilde Topa1,2, Maurizio Vecchi1,2, Luisa Doneda5, Alice Scricciolo1, Vincenza Lombardo1 and Leda Roncoroni1,5
Abstract The outbreak of COVID-19 and SARS-CoV-2 infection is spreading worldwide as the first coronavirus pandemic. The clinical picture is variable but flu-like symptoms are common with bilateral interstitial pneumonia being the most frightening presentation. No specific therapies nor vaccine have been developed to date and the only way to limit the virus diffusion is by modifying one’s lifestyle limiting social life and following strict hygienic precautions. No data is available on the risk of COVID-19 and its outcomes in celiac disease (CeD). The restrictions applied to counter COVID-19 can impact on CeD treatment and gluten-free dieting, the only available therapy for CeD. With the present manuscript, we aim to support gastroenterologists and nutritionists in the management of CeD patients in the new pandemic scenario, being conscious that availability and local situations are extremely various. Keywords: Celiac disease, COVID-19, SARS-CoV-2, Gluten-free diet Background During the dramatic coronavirus (COVID-19) pandemic, many Italian patients affected by celiac disease (CeD) have asked gastroenterologists about their possible risk of SARS-CoV-2 infection and if their condition would in any way make the lung disease worse [1]. Actually, little is known about Severe Acute Respiratory Syndrome— CoronaVirus 2 (SARS-CoV-2) infection, especially among Western populations, and if and how subjects with an on-going autoimmune disorder (e.g. CeD) [2] are affected. From this point of view, CeD is considered a long-life autoimmune disorder of the small bowel (SB) caused by the ingestion of gluten-containing food in *Correspondence: [email protected] 1 Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy Full list of author information is available at the end of the article
genetically susceptible subjects carrying the HLA DQ2 and/or DQ8 haplotypes and affecting approximately 1% of the general population [3]. The main hallmarks of CeD are the serological presence of autoantibodies (anti tissue transglutaminase and anti endomysial IgA) and duodenal atrophy, characterised by villous shortening, crypt hyperplasia and increased intra-epithelial lymphocytes (IELs) [4]. Being one of the most common autoimmune diseases (approximately 0.5% of the general population can be affected by CeD) [5], the possibility of any interaction between SARS-CoV-2 infection and the immune system of CeD subjects could be clinically and epidemiologically relevant. Nowadays, no data and no indications are present about this important issue. The present study aim
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