CELIAC-DISEASE AND TYPE-I (INSULIN-DEPENDENT) DIABETES-MELLITUS IN CHILDHOOD - FOLLOW-UP-STUDY

To ascertain the specificity of IgA and IgG antigliadin (IgA-AGA, IgG- AGA), IgA-antireticulin (R1-ARA), and antiendomysial (AEA) antibodies for the diagnosis of celiac disease, we evaluated 133 type I diabetic children aged 1.4-28.4 years (mean 14.1 +/- 6.6), with diabetes from o nset to 20.5 years. Fifty-three patients were considered at onset and 69 of these also during follow-up. IgA-AGA and IgG-AGA were determined by enzyme-linked immunosorbent assay (ELISA), R1-ARA and AEA by indir ect immunofluorescence. IgA-AGA were positive in 20 of 133 (15%), IgG- AGA were positive in seven of 133 (5.26%), while R1-ARA and AEA were p ositive in three patients. At the onset of disease rye found elevated IgA-AGA in 17 of 53 (32%) patients, IgG-AGA in four (7.55%) patients, three of them with IgA-AGA as well; R1-ARA and AEA were present in thr ee (5.66%) patients, all with high IgA-AGA levels. During 1-10 year fo llow-up IgA-AGA decreased to within the normal range in 13 patients wi th elevated IgA-AGA at onset but without RI-ARA and AEA; in four patie nts with high IgA-AGA at onset, IgA-AGA remained constantly elevated a s did R1-ARA and AEA in three of them; and two patients, without IgA-A GA, R1-ARA, and AEA al onset, became positive for all three antibodies . Intestinal biopsy confirmed a diagnosis of celiac disease in five of these with IgA-AGA, R1-ARA, and AEA, but not in one patient with pers istent IgA-AGA but no AEA and RI-ARA, suggesting that R1-ARA and AEA a re more reliable markers for the screening of celiac disease in type I diabetic patients.