Can Gluten Sensitivity Be a Multisystem Disorder?
Angela Witzel, DVM, PhD, DACVN, Clinical Associate Professor of Nutrition, University of Tennessee Veterinary Medical Center, United States of America
In the Literature
Lowrie M, Hadjivassiliou M, Sanders DS, Garden OA. A presumptive case of gluten sensitivity in a border collie: a multisystem disorder? Vet Rec. 2016;179(22):573.
The Research …
Gluten-free diets and celiac disease have garnered widespread attention in human medicine. Whereas celiac disease is generally associated with GI signs, gluten-related disorders (GRDs) affecting multiple body systems in humans have been described.1
Celiac and several other GRDs occur due to immune-mediated intolerance to proteins in gluten; the mechanism behind nonceliac gluten sensitivity has not been determined.2 Gluten intolerances similar to celiac disease have been described in Irish setters.3 Neurologic signs have also recently been attributed to a gluten intolerance in border terriers.4
This case report was the first to describe a potential GRD affecting multiple body systems. A 2-year-old border terrier with a history of pruritus, otitis, postprandial neurologic episodes, abdominal pain, and primarily large-bowel GI signs was evaluated. The patient was screened for pancreatitis, exocrine pancreatic insufficiency, and dysbiosis. Bile acid stimulation and fasting ammonia test results were normal. Thoracic and abdominal images were normal, but endoscopy with GI biopsy results were consistent with mild-to-moderate gastritis, enteritis, and colitis with lymphocytic, plasmacytic, and eosinophilic infiltrates.
Diagnosis of celiac disease in humans often uses serum antibody testing of antitransglutaminase 2 (TG2) and antigliadin (AGA)5; this dog had levels approximately 5 times higher than those reported in normal dogs.4 The diet history provided in the case report was vague, but the authors stated the patient had previously undergone novel protein dietary trials with no improvement. The patient was started on a gluten-free hydrolyzed diet; 14 days later, neurologic, GI, and skin-related clinical signs resolved. In addition, titers repeated 12 weeks later showed significant decreases in TG2 and AGA antibodies, although values were still higher than those seen in normal dogs.
Although these results suggest a multisystemic gluten intolerance, the hydrolyzed diet may have improved a combination of inflammatory bowel disease and food-allergic dermatitis. Gluten intolerance could have been evaluated by adding gluten to the patient’s hydrolyzed diet and noting whether clinical signs returned.
… The Takeaways
Key pearls to put into practice:
Gluten-related disorders are rare in veterinary medicine. Reports describe clinical signs primarily affecting the GI tract in Irish setters and the neurologic system in border terriers.
This case suggests that gluten sensitivity cases may be presented with a combination of GI, neurologic, and pruritic skin disorders. However, more research is needed.
In patients suspected of having a gluten sensitivity, testing for TG2 and AGA antibodies should be considered.