Celiac Disease and Dermatitis Herpetiformis: A Gluten-Sensitive Enteropathy

By SWA

Celiac disease, also known as gluten-sensitive enteropathy, is an autoimmune condition where the body’s immune system reacts abnormally to gluten—a protein found in wheat, rye, and barley. This response results in damage to the small intestine and impaired nutrient absorption. Another closely related condition, Dermatitis Herpetiformis (DH), is a skin manifestation of celiac disease, presenting as intensely itchy, blistering rashes. Both conditions share a common underlying cause: intolerance to gluten, specifically to the gliadin fraction of gluten, which triggers an autoimmune response.

In this article, we'll explore the details of celiac disease and dermatitis herpetiformis, their symptoms, diagnosis, and treatment, as well as key dietary considerations for those affected.

In addition:

ATI (Amylase/Trypsin Inhibitors) are proteins found in wheat and other cereals. They're part of the plant's natural defense system against pests, but in humans, they can trigger immune responses.

ATIs have been linked to wheat-related health issues, such as:

  • Food allergies

  • Baker’s asthma (respiratory reactions)

  • Coeliac disease (though gluten is the main trigger, ATIs may worsen symptoms)

  • Non-coeliac wheat sensitivity

So, while they’re not the same as gluten, ATIs can contribute to wheat intolerance and inflammation, especially in sensitive individuals.

Reference: Wheat amylase/trypsin inhibitors (ATIs): occurrence, function and health aspects
https://pmc.ncbi.nlm.nih.gov/articles/PMC9363355/

Celiac Disease: An Overview

Celiac disease is more serious than a typical food intolerance. It occurs when the immune system attacks gluten in the small intestine, causing inflammation and damage to the intestinal lining, specifically the villi—tiny finger-like structures responsible for nutrient absorption. As the villi become damaged, the intestine can no longer absorb nutrients properly, leading to a host of health issues including malnutrition, anemia, and other complications.

Common Symptoms of Celiac Disease:

  • Diarrhea
  • Fatigue
  • Weight loss
  • Bloating and gas
  • Abdominal pain
  • Nausea and vomiting
  • Constipation

The progression of celiac disease can be divided into five clinical stages:

  1. Classic celiac disease: Characterized by typical gastrointestinal symptoms such as diarrhea, malabsorption, and weight loss.
  2. Non-classic celiac disease: Presents with atypical symptoms like anemia, fatigue, or osteoporosis, without obvious gastrointestinal symptoms.
  3. Subclinical celiac disease: Minimal or no symptoms but positive for celiac antibodies and intestinal damage.
  4. Potential celiac disease: Positive antibodies but no intestinal damage yet.
  5. Refractory celiac disease: When the condition does not respond to a gluten-free diet, potentially leading to severe complications.

For more detailed information about the progression of celiac disease, its diagnostic modalities, and treatment options, you can refer to this resource.

The study concludes that in patients with micronutrient deficiencies caused by celiac disease, vitamin supplements may be necessary. Micronutrient deficiencies (in particular, iron, folic acid, vitamins B6 and B12, vitamin D, copper, and zinc) are common in celiac patients.
 https://celiac.org/2019/08/22/dietary-supplementation-advice-for-celiac-patients-on-a-long-term-gluten-free-diet/

Dermatitis Herpetiformis: The Skin Manifestation of Celiac Disease

Dermatitis Herpetiformis (DH) is a chronic, blistering skin condition that appears as a result of gluten sensitivity and is considered a cutaneous manifestation of celiac disease. DH affects about 10% of people with celiac disease and is strongly associated with gluten intolerance. More than 90% of individuals with DH have some degree of gluten-sensitive enteropathy.

Symptoms of DH:

  • Intense itching and burning sensation on the skin
  • Small, fluid-filled blisters (vesicles) that are often scratched open
  • Symmetrically distributed rashes, often on the elbows, knees, buttocks, scalp, and shoulders
  • Post-inflammatory changes such as hypopigmentation (light spots) and hyperpigmentation (dark spots)

Interestingly, the skin rash in DH is triggered by the same autoimmune reaction that damages the gut in celiac disease. Gluten ingestion results in the formation of IgA antibodies that target both the small intestine and the skin. In DH, these antibodies are deposited in the skin, leading to inflammation and blister formation.

Diagnosis of DH requires a direct immunofluorescence test of a skin biopsy, which shows deposits of IgA antibodies at the dermoepidermal junction. A characteristic "picket-fence" appearance of these antibody deposits can often be seen in DH patients.

Treatment and Management

The primary treatment for both celiac disease and dermatitis herpetiformis is a strict gluten-free diet. Eliminating gluten from the diet helps to reduce intestinal damage, alleviate symptoms, and prevent complications. It also resolves the skin manifestations in DH over time, although skin symptoms may take longer to subside after starting a gluten-free diet.

In addition to a gluten-free diet, DH may be treated with dapsone, a medication that helps to relieve the intense itching and blistering. However, dapsone does not treat the underlying cause of DH, so adherence to a gluten-free diet is crucial for long-term control of the condition.

For more information about managing celiac disease, including food guidelines, check out NHS resources on coeliac disease.

Potentially Harmful Vitamins or Supplements (for people with celiac)

  1. Supplements with gluten-containing fillers

    • Some cheaper or generic supplements may use wheat starch or barley-based additives.

    • Look for labels like “gluten-free”, or check with the manufacturer if you're not sure.

  2. Vitamin E (from wheat germ oil)

    • Not all vitamin E is a problem, but if it’s derived from wheat germ and not processed correctly, it could contain gluten.

  3. Multivitamins

    • These often have many ingredients, and it's easy for gluten to sneak in via binders or flavorings.

  4. Herbal or “natural” supplements

    • These are less regulated and may not list all ingredients clearly. Contamination during manufacturing is also more common.

What to Look For Instead

  • Always choose certified gluten-free supplements.

  • Brands like NOW Foods, Nature Made (select products), Pure Encapsulations, and Garden of Life often have gluten-free options.

  • If unsure, consult your doctor or a dietitian who specializes in celiac disease.

Dietary Considerations

Individuals with celiac disease and DH must avoid all foods containing gluten. This includes grains such as wheat, rye, barley, and products made from them. However, many other grains and food items are naturally gluten-free and safe to consume.

Foods to avoid:

  • Wheat and wheat-based products (e.g., bread, pasta, baked goods)
  • Barley
  • Rye
  • Couscous
  • Semolina

Safe gluten-free alternatives:

  • Rice
  • Corn (maize)
  • Potatoes
  • Quinoa
  • Buckwheat
  • Polenta
  • Gluten-free oats (certified)

It is important for individuals with celiac disease to read labels carefully, as gluten is often hidden in processed foods. Gluten can also be found in unexpected products such as soups, sauces, and even medications.

For more guidance on gluten-free grains, download a handy guide to gluten-free grains from reputable celiac disease organizations.

Complications and Associated Conditions

Celiac disease can have far-reaching effects on various organ systems due to malabsorption and chronic inflammation. Apart from intestinal and dermatological symptoms, individuals with celiac disease may experience other complications such as:

  • Nutrient deficiencies: Due to impaired absorption of essential vitamins and minerals.
  • Lactose intolerance: Damage to the intestinal lining can lead to a temporary inability to digest lactose.
  • Ocular conditions: Dry eyes and cataracts can occur as a result of malnutrition, particularly deficiencies in vitamin A.
  • Bone health issues: Osteoporosis may develop due to poor calcium absorption.

Conclusion

Celiac disease and its skin manifestation, dermatitis herpetiformis, are chronic autoimmune conditions caused by an immune response to gluten. Both conditions can cause significant discomfort and lead to serious complications if left untreated. However, with early diagnosis and strict adherence to a gluten-free diet, individuals with celiac disease and DH can manage their symptoms effectively and prevent long-term damage to their health.

It is important to consult with a healthcare provider if you suspect you have celiac disease or DH, as accurate diagnosis and proper treatment are essential for living a healthy life.

However, we reported a strong interaction between butyric acid and CD.
See: Very Long-Chain Fatty Acids (VLCFAs) X-ALD and Spinal Muscular Atrophy (SMA): Exploring the Connection: https://swaresearch.blogspot.com/2024/10/very-long-chain-fatty-acids-vlcfas-and.html

For additional resources and support, visit NHS.coeliac disease for more information on living gluten-free and managing this autoimmune condition.

References:

© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right.
Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9

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