Dear Editor,
We read with great interest the recent original article published in “The Turkish Archives of Pediatrics” by Tuhan et al. (1) about celiac disease (CD) in children with Hashimoto’s thyroiditis. However, we would highlight important points related to the reported method because the authors did not explore the genetic susceptibility to developing CD.
Celiac disease is a well-recognized auto-immune enteropathy involving genetic factors, and is associated in almost all patients to specific susceptibility alleles encoding human leucocyte antigen (HLA) histocompatibility antigens, the corresponding genes being localized at the major histocompatibility region in the short arm of chromosome 6.
Epidemiologically, more than 95% of patients with CD share the HLA-DQ2 heterodimer, and the remainder present the HLA-DQ8 heterodimer (2). Present in nearly all patients with CD, these risk-haplotypes have a negative predictive value of CD approaching 100% (3); thus, they are widely used to exclude CD in targeted populations. On the other hand, there is good evidence to show an increased prevalence of CD with autoimmune diseases such as type 1 diabetes and autoimmune thyroid disease (2). In this optic, HLA typing emerges as an important tool able to discriminate individuals genetically susceptible to CD in at-risk groups such as those with autoimmune conditions (e.g., thyroiditis) (4).
Recent guidelines from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) for the diagnosis and treatment of celiac disease recommend that HLA testing for CD should be offered to asymptomatic children and adolescents if they carry an increased risk for CD such as in autoimmune thyroiditis. In addition, this test is probably more cost effective than serial serologic evaluations because it confers a life-long genetic susceptibility profile (5).
Thus, we advocate that HLA typing could be indicated at first-line to exclude CD in specific, at-risk populations such as those presenting with the autoimmune Hashimoto’s disease.
References
- 1.Tuhan H, Işık S, Abacı A, et al. Celiac disease in children and adolescents with Hashimoto thyroiditis. Turk Pediatri Ars. 2016;51:100. doi: 10.5152/TurkPediatriArs.2016.3566. [DOI] [PMC free article] [PubMed] [Google Scholar]
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