Does having celiac disease make you immunocompromised?

Bronwyn Hamilton, MD
Does having celiac disease make you immunocompromised?

Answer


This topic is a bit controversial. From the conventional point of view in the US, celiac disease does not make you immunocompromised. We generally think of this as patients on powerful immunosuppressive medications, such as those for organ transplants, HIV infection, or people being treated with chemotherapy for cancer, as typical examples. However, there is a spectrum of immune competence, and patients with diabetes, obesity, low vitamin D are also relatively immune suppressed, given these patients have a higher risk for infections and infection severity, even if not under the traditional “immunocompromised” umbrella. For example, that vitamin D supplementation and keeping blood sugars in good control are associated with a reduction in the risk of severe infections.

There is research showing that patients with celiac disease can have functional hyposplenism (estimated to occur in 33-76% of celiac patients), which is a poorly functioning spleen1. This does put celiac patients at elevated risk for infection by “encapsulated” bacteria (those ensheathed in a polysaccharide, or sugar-based capsule). The spleen is crucially important in immune responses to these types of bacterial infections. Functional hypopsplenism puts celiac patients at higher risk for potentially serious infections such as “strep” throat or pneumococcal meningitis that carry significant risks for severe complications or can even be fatal. So, celiac patients with functional hyposplenism do have a higher risk for severe bacterial infections and are immunocompromised. Most physicians do not test for hyposplenism, but it can be assessed through evaluation of a peripheral blood smear under the microscope to look for the presence of “pitted” red blood cells. Another less specific test could include imaging to assess for spleen atrophy (small size related to poor function).

There is a relatively simple and effective way to reduce the risk and morbidity of these infections, and it is pneumococcal vaccination. These vaccinations are recommended for elderly people > 65 years of age and young children (old and young age are also a relatively immunocompromised state) or for patients who have had their spleen removed. Some societies recommend it for celiac disease patients as well, but many doctors may not be aware of this. A recent meta-analysis showed an elevated risk for pneumococcal illness in celiac disease patients, and the authors state that pneumococcal vaccine should be considered in celiac disease2. Despite this, the US fell short of making a strong recommendation for celiac patients because it has not been adequately studied3. However, other countries do make this recommendation. You can request this vaccine from your primary care doctor; if they are reluctant, I suggest providing the references provided here.

Pneumococcal vaccination is recommended by Coeliac UK in Great Britain based on recommendations from the Health Advisory Council and by the British Society of Gastroenterology (based on a multidisciplinary panel including 18 physicians from 8 different countries). This recommendation was based on the potential for sepsis (life-threatening blood infection) in celiac disease due to hyposplenism, and they recommend vaccination including a booster every 5 years4.

References:

  1. Julian T, Hadjivassiliou M, Zis P. Gluten sensitivity and epilepsy: a systematic review. J Neurol. 2019 Jul;266(7):1557-1565.
  2. Kirkineska L, Perifanis V, Vasiliadis T. Functional hyposplenism. Hippokratia. 2014 Jan;18(1):7-11.
  3. Simons M, Scott-Sheldon LAJ, Risech-Neyman Y, Moss SF, Ludvigsson JF, Green PHR. Celiac Disease and Increased Risk of Pneumococcal Infection: A Systematic Review and Meta-Analysis. Am J Med. 2018 Jan;131(1):83-89.
  4. Ludvigsson JF, Bai JC, Biagi F, Card TR, Ciacci C, Ciclitira PJ, Green PH, Hadjivassiliou M, Holdoway A, van Heel DA, Kaukinen K, Leffler DA, Leonard JN, Lundin KE, McGough N, Davidson M, Murray JA, Swift GL, Walker MM, Zingone F, Sanders DS; BSG Coeliac Disease Guidelines Development Group; British Society of Gastroenterology. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut. 2014 Aug;63(8):1210-28.

Published January 8, 2024

Note: This information is provided by NCA and Bronwyn Hamilton, MD. This information is meant for educational purposes only and is not intended to substitute for personalized medical advice or replace any medical advice provided directly to you by your health care provider. No liability is assumed by the NCA or Bronwyn Hamilton, MD by providing this information.

Visited 462 Times, 2 Visits today