Development of celiac disease-associated antibodies in offspring of parents with Type I diabetes

Aims/hypothesis. The aim of this study was to determine the frequency and t emporal development of antibodies related to celiac disease in offspring of parents with Type I (insulin-dependent) diabetes mellitus. Methods. Sera from 913 offspring of parents with Type I diabetes prospectiv ely followed from birth to the age of 8 years were tested for IgG-transglut aminase antibodies (IgG-tTGCAs), endomysial IgA antibodies (EMA) and gliadi n antibodies. Results. We found tTGCAs in 32 (3.5%) of the 913 relatives. Prevalence was related to age and reached 6.5% at age 8 years. Endomysial IgA antibodies w ere detected in 44% of the relatives with tTGCAs and 0.6% of tTGCA negative relatives and were also most prevalent (5%)in those aged 8 years. Both tTG CAs and EMAs were more frequent in relatives with the HLA DRB1*03 DQA1*0501 DQB1"02 haplotype (7.1% and 7.2%, respectively; p < 0.005). Antigliadin an tibodies were common in both tTGCA positive (42%) and negative (23%) relati ves, did not show a relation with age and were less prevalent in relatives with HLA DR3 (p < 0.05). There was no association between the presence of a ntibodies associated with celiac disease and islet autoantibodies in these relatives. Of the relatives 15 (1.6%) had tTGCAs plus EMAs. In two of these , anti-gliadin antibodies were detected before the detection of tTGCAs and EMAs at the age of 9 months whereas none of the remainder had any antibodie s associated with celiac disease before age 2 years. In three there were no detectable antigliadin antibodies in any of the samples tested. Celiac dis ease without clinical symptoms was diagnosed in 9 of 12 by intestinal biops y. Conclusion/interpretation. A statistically significant proportion of relati ves of patients with Type I diabetes have celiac disease-associated autoimm unity and the silent form of celiac disease early in life. These relatives should, therefore, be considered for celiac antibody screening.