Coronavirus disease 2019 (COVID-19) was initially reported in China but rapidly spread around the world and caused a serious threat to global public health [1]. In face of the current situation, the celiac community raised a lot of concerns regarding celiac disease (CD) susceptibility and risk for severe COVID-19. Hence, we aimed to briefly review the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in celiac patients.
CD is an autoimmune disorder that affects the small bowel in genetically predisposed individuals precipitated by the ingestion of gluten [2]. Celiac patients, in general, are not considered to be immunocompromised. Indeed, the immune system of those under a strict gluten-free diet and with controlled disease is similar to the rest of the population. However, the small proportion of patients with refractory CD are usually under immunosuppressive or ablative treatments, which makes them more susceptible to a wide range of infections.
Hyposplenism or functional asplenia in association with CD may result in impaired immunity to encapsulated bacteria. In fact, it has been reported an increased risk of severe diseases due to pneumococcal bacteria [2]. Celiac patients are also predisposed to a number of other infections such as influenza and Clostridium difficile. Most CD-related organizations encourage vaccination for Streptococcus pneumoniae during the pandemic because of the risk of co-infection in COVID-19 [3].
CD is often associated with other autoimmune diseases, such as thyroid disorders, rheumatoid arthritis and type 1 diabetes mellitus [2]. This last one has particular importance since mortality seems to be threefold higher in people with diabetes compared with the general mortality of COVID-19 [4]. Moreover, while there have not been many studies looking at respiratory complications of COVID-19 in patients with autoimmune diseases or in those under immunosuppressive therapy, there have already been case reports of other types of coronaviruses causing pneumonia in immunocompromised individuals.
Handwashing is one of the best ways to reduce spread of coronaviruses. The Centers for Disease Control recommends hand hygiene with soap and water or, alternatively, hand sanitizer with at least 60% alcohol [5]. There is a constant concern in the celiac population to inadvertently ingest gluten after using a cleaning product. Gluten cannot be absorbed by the skin and the basic active ingredients in an alcohol-based hand sanitizer do not contain gluten. Nevertheless, some disinfectants may contain ingredients derived from gluten, such as wheat germ oil. Thereby, it is recommended careful reading of the label, as with all other products.
There have been no studies suggesting severe illness from COVID19 in patients with CD, however, there is still little experience of SARS-CoV-2 infection in celiac patients. It is suggested to keep close surveillance of these patients and encourage control of their disease, as well as take preventive measures against COVID-19.
Acknowledgements
Guarantor of the article: I.G. I.G. drafted the manuscript. All authors have critically revised and finalized the manuscript. All authors have approved the final version of the manuscript.
Conflicts of interest
There are no conflicts of interest.
References
- 1.del Rio C, Malani N. 2019 novel coronavirus – important information for clinicians. JAMA 2020. doi: 10.1001/jama.2020.1490. [DOI] [PubMed] [Google Scholar]
- 2.Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United Eur Gastroenterol J 2019; 7:583–613. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Celiac Disease Foundation. Celiac Disease and COVID-19. 2020; https://celiac.org/celiac-disease-and-covid-19/. [Accessed June 19, 2020]
- 4.Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020. doi: 10.1001/jama.2020.2648. [DOI] [PubMed] [Google Scholar]
- 5.Centers for Disease Control and Prevention. Hand Hygiene Recommendations. 2020; https://www.cdc.gov/coronavirus/2019-nCoV/index.html. [Accessed June 19, 2020]