Introduction
Celiac disease is an autoimmune illness caused by a lack of tolerance for gluten, a protein found in or added to various foods. Celiac disease causes inflammation of the mucosa by damaging the small intestine. Severe complications like diarrhea, bloating, gas, anemia, abdominal pain, nausea, vomiting, heartburn, and constipation result from celiac disease. COVID-19 or coronavirus 2019 is a contagious respiratory illness caused by a novel coronavirus, i.e., SARS-COV-2. It spreads when an infected person carrying the virus transmits through talks, sneezes, coughs, or shakes hands without proper sanitation. Each of these acts causes tiny droplets to project into the surrounding area, often traveling through the air for up to 6 feet. According to CDC, adult patients suffering from the following diseases are at high risk of getting COVID-19:
- Cancer
- Chronic Lung Diseases (Asthma, COPD, cystic fibrosis, and pulmonary hypertension)
- Diabetes
- Heart Diseases (hypertension, cardiomyopathies, heart failure)
- Immune-compromised state or suffering from Immune Deficiency disease
- Obesity
- Chronic Liver Disease
- Sickle cell disease
Since celiac disease is an autoimmune disease, through this article, we will know if a patient with celiac disease is also at high risk of getting COVID-19.
Are Celiac Disease patients susceptible to viral infections?
When people with celiac disease hear the phrase “immunocompromised,” they may worry if they fall into this category and should be more concerned about their COVID-19 risks. According to the National Celiac Association (NCA), while celiac disease is an immune-related reaction, clinicians do not consider celiac disease patients immunocompromised.
However, the NCA does indicate that people with celiac disease (particularly active celiac disease, in which a person has common celiac disease symptoms) are more susceptible to infections.
According to the Celiac Disease Center reports at Columbia University Medical Center, when people have celiac disease, they have a higher risk of pneumonia infections caused by pneumococcal bacteria. However, the Celiac Disease Center also points out that these hazards are typically only marginally elevated relative to the general population and are only discovered in limited research.
Doctors are unsure if patients with celiac disease and COVID-19 would experience similar increases in worsened outcomes.
Has there been any study to prove the relationship between Celiac disease and Covid-19?
In a 2021 published research article in the Clinical Epidemiology, Vol.13 journal, Jonas F Ludvigsson et al. carried out a population-based cohort study among celiac disease patients in Sweden to establish a relationship between celiac disease and severe outcomes of COVID-19. The scientists concluded from the survey that there was not an increased risk of hospitalization, or admission to intensive care unit, or mortality to COVID-19 among celiac disease patients.
Similarly, in another published article in the autoimmunity reviews journal in 2020, Fabiana Zingone et al. carried out an observational study on 171 celiac disease patients on a gluten-free diet for at least six months. Although 18 subjects showed flu-like symptoms, the researchers concluded from the study data that celiac disease patients are not at higher risk of COVID-19.
Risk factors of Covid patients with Celiac disease
SECURE-Celiac, an international adult and pediatric registry, is presently collecting data of celiac patients who have been diagnosed with COVID-19. These patients need to visit their healthcare providers, who will help them submit a report to covidceliac.org. In addition, the iCureCeliac patient registry is also gathering patient-reported data where one can share the experiences of their child who has been diagnosed with COVID-19 infection. Data from these registries will reveal COVID-19’s total impact on celiac patients.
According to the Celiac Disease Foundation Medical Advisory Board, celiac disease patients are not immunocompromised. Therefore, a tiny percentage of CD patients with significant malnutrition and weight loss, patients on immunosuppressive drugs, or who have other significant illnesses may be at risk of severe sickness from COVID-19 and should visit their doctors. However, the CD Foundation Medical Advisory Board does not believe that cross-contact gluten exposure puts a patient with CD at an increased risk of severe illness from COVID-19. However, it does recommend that patients follow a rigorous gluten-free diet for overall health.
Among celiac disease patients, there appears to be an increased risk of pneumonia and herpes zoster infections caused by the pneumococcal bacteria (causing shingles). Furthermore, there seems to be an increased risk of worsening outcomes from influenza infections and a poor response to hepatitis B vaccination. Nonetheless, while these dangers have been quantified in various studies, they are minor insignificance. Thus, it’s plausible to believe that people with celiac disease, particularly the elderly, are at a somewhat higher risk of having harmful consequences from infections with this new virus.
Conclusion
Celiac disease is defined by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) as “a chronic digestive and immunological illness that destroys the small intestine.” The NIDDK goes on to say that gluten-containing meals can cause symptoms of the condition. It can produce long-term digestive issues, preventing the body from receiving all of the nutrients it requires. The FDA specifies the chemicals in Pfizer, Moderna, and Johnson & Johnson vaccines on its website, and none of them had gluten. According to the FDA and Dr. David Sullivan, an infectious disease expert, the body’s reaction to a gluten shot is different from when gluten is consumed through food. Therefore, celiac disease patients should take COVID-19 vaccines without worrying about gluten intolerance and should follow COVID-19 guidelines issued by the government for the general public to stay safe from the pandemic.
References
- How does COVID-19 affect people with celiac disease? Accessed at
https://www.medicalnewstoday.com/articles/covid-19-and-celiac-disease#precautions - People with Certain Medical Conditions. Accessed at
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html - Celiac Disease and COVID-19. Accessed at
https://celiac.org/celiac-disease-and-covid-19/ - Lebwohl B, Larsson E, Söderling J, Roelstraete B, Murray JA, Green PHR, Ludvigsson JF. Risk of Severe Covid-19 in Patients with Celiac Disease: A Population-Based Cohort Study. Clin Epidemiol.2021;13:121-130 https://doi.org/10.2147/CLEP.S294391
- Zingone, F., D’Odorico, A., Lorenzon, G., Marsilio, I., Farinati, F., & Savarino, E. V. (2020). Risk of COVID-19 in celiac disease patients. Autoimmunity reviews, 19(10), 102639. https://doi.org/10.1016/j.autrev.2020.102639
- VERIFY: No, COVID-19 vaccines don’t contain gluten. Accessed at
https://www.wusa9.com/article/news/verify/covid-19-vaccines-dont-contain-gluten-safe-for-celiac/507-85bdc77c-136c-44e6-926d-3ea055fbf8bb
