Podcast Update - End of Season 1
The Pastore Podcast
enAugust 20, 2020
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About this Episode
Dr. Pastore discusses Dermatitis Herpetiformis - an autoimmune condition with skin rashes that is caused by the consumption of gluten.
He covers who is most at risk, what this autoimmune condition is, how to get properly diagnosed and the celiac disease connection.
Discussed:
Dermatitis Herpetiformis (DH) is NOT the same as celiac disease. The majority of those with DH also have celiac disease, however there are people that only have DH and not celiac disease, and vice versa.
DH is an autoimmune reaction where antibodies (IgA) are formed after the consumption of gluten, which travels in bloodstream and are deposited in skin. This signals a reaction that creates itchy/blistering skin or bumps, resembles herpes-like lesions.
DH is misdiagnosed 95% of the time for eczema.
The prominent sign that it is DH and not eczema is that rashes will occur on both sides of body - typically around the knees, scalp, buttocks, elbows.
DH is diagnosed via skin biopsy, as 20% of patients have normal blood and intestine testing for celiac. Most have no gastrointestinal issues.
If you or a relative had Hashimoto’s thyroiditis, Grave’s disease, Celiac disease, type 1 diabetes, lupus, or Sjogren's syndrome and you have eczema-like rash, speak to your doctor about a skin biopsy.
Misdiagnosed DH patients that are prescribed Prednisone/topical corticosteroids creams can mask symptoms temporarily, then cause a rebound flare-up.
Consuming other food intolerances (besides gluten) can make DH worse.
A gluten free diet combined with the antibiotic dapsone (topical or orally) is the common treatment for DH. It can take up to 2 years for full skin recovery.
Iodine and Nonsteroidal anti-inflammatory drugs (NSAIDs) can also cause or worsen flares. Iodine is found in: cough medicine, iodized salt, shellfish, seaweed/kelp/nori, yogurt, milk, and iodine supplements.
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Show notes will be available Tuesday, August 4th at drrrobertpastore.com/podcasts
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If you suffer from seasonal allergies or hay fever, there may be a connection to fruit and/or vegetable food allergies.
University of Manchester webpage for foods cross-reacting with pollen http://research.bmh.manchester.ac.uk/foodallergens/facts/pollen/pollenandfood/
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Show notes:
The Pastore Podcast
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Show notes:
https://drrobertpastore.com/podcasts/069-new-gluten-exposure-testing
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If you have cardiovascular disease, get tested for celiac disease. If you have celiac disease, request that your cardiovascular health be evaluated.
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https://drrobertpastore.com/podcasts/067-celiac-cardiovascular
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On Refractory Celiac Disease
Continuing with topics around Celiac Disease Awareness Month, Dr. Pastore discusses a condition that some diagnosed celiacs are still faced with - refractory celiac disease.
He covers what it is, how it’s diagnosed, how common it is amongst diagnosed celiac disease patients, the signs and symptoms to look out for, causes, treatments, secondary food reactions and what to discuss with your physician.
The 6 Steps to Diagnosing Refractory Celiac Disease:
1. Review the original diagnosis of celiac disease, going back as far as you can to in the medical records, including the original biopsy, serology, DNA, etc., and then you must have confirmation that the patient was following a strict GF diet for at least 1 year but still has symptoms and villi damage. You want to be certain there is no gluten contamination because that could rule out RCD quickly.
2. Identify any other condition that can negatively impact the villi including cancers such as intestinal lymphoma, inflammatory bowel disease such as Crohn’s disease, microscopic colitis, hypogammaglobulinemia (is an immune system abnormality that results in reduced antibody production making enough antibodies called immunoglobulins) and believe it or not, even small intestinal bacterial overgrowth – if severe enough, and over use of NSAIDS or reaction to NSAIDS, etc.
3. Andoscopy and colonoscopy must be performed, with biopsies taken at both sites.
4. If possible, a capsule endoscopy (basically swallowing a camera in a pill format). You can obtain excellent images and identify some inflammation and ulceration.
5. If warranted, a CT scan (computerized tomography) and MRE (Magnetic resonance enterography) as well as a barium x-ray (A barium X-ray is a radiographic (X-ray) examination of the gastrointestinal (GI) tract. Barium absorbs x-rays and appears white on the images. These tests should be done particularly if there is any suspicion of lymphoma. There may be multiple diagnoses during the search for the cause behind suspected refractory celiac disease.
6. Fecal fat and pancreatic tests should be completed as well.