International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: Editor-in-chief: Samasca Gabriel
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International Journal of Celiac Disease. 2014, 2(2), 58-63
DOI: 10.12691/ijcd-2-2-7
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The Effect of Enzyme Therapy on Skin Symptoms and Immune Responses in Patients with Dermatitis Herpetiformis

Agnieszka Zebrowska1, Hugh J. Cornell2, Finlay A. Macrae3, Anna Sysa-Jedrzejowska1, Elzbieta Waszczykowska1 and Teodor Stelmasiak4

1Department of Dermatology and Venereology, Lodz Medical University, Lodz, Poland

2School of Applied Science, RMIT University, Melbourne, Victoria, Australia

3Department of Colorectal Medicine and Genetics, and University of Melbourne Department Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia

4Glutagen Pty Ltd, Maribyrnong, Victoria, Australia

Pub. Date: May 14, 2014

Cite this paper:
Agnieszka Zebrowska, Hugh J. Cornell, Finlay A. Macrae, Anna Sysa-Jedrzejowska, Elzbieta Waszczykowska and Teodor Stelmasiak. The Effect of Enzyme Therapy on Skin Symptoms and Immune Responses in Patients with Dermatitis Herpetiformis. International Journal of Celiac Disease. 2014; 2(2):58-63. doi: 10.12691/ijcd-2-2-7


Background: The aetiology of coeliac disease (CD) has many similarities to that of dermatitis herpetiformis (DH), except that DH lesions are mainly manifested in the skin. Mucosal enzyme deficiency plays an important part in CD pathology. Clinical studies indicated that the gluten exposure in CD could be partly corrected by the use of enzyme supplementation. Objective: Enzyme therapy, using enterically coated tablets containing caricain, was investigated as a means of protecting patients with DH against wheat gluten. Methods: A randomized, placebo-controlled clinical trial was carried out on 20 DH patients in clinical remission. The patients were divided into two groups of 10, one group given a placebo daily and the other the enzyme – containing tablets. Both groups were challenged with 6g of gluten daily in a double-blind trial. Symptoms and signs of skin involvement were recorded and graded at the start of the trial, after 7 days and after 14 days. Blood was also taken at the start and after 14 days and assayed for IgA EMA and anti-gliadin antibodies. Results: After 7 days the major features associated with DH were more severe and more common with the placebo compared with enzyme therapy. Before 14 days, seven patients in total, six on placebo, had to withdraw from the trial because of the effects of the gluten challenge whilst 2 patients on therapy developed blisters, erythema and itching. Serological tests indicated that IgA EmA antibodies and anti-gliadin antibodies after 14 days were not affected significantly, but indicated that abnormally high antibodies titers of both types were present in 8 patients at the start of the trial, suggesting the need for enzyme therapy in addition to the normal gluten-free diet for patient well-being. Conclusions: This study supports the use of enzyme supplementation as a safeguard for patients with DH on a nominal gluten-free diet.

dermatitis herpetiformis coeliac disease gluten caricain enzyme therapy IgA endomysial antibodies antigliadin antibodies

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