Researchers are continuously trying to understand the upsurge of celiac disease. While predisposition has been known as a factor, it does not explain the sharp rise, as genes are not changing that fast.
So, there must be environmental factors responsible in some way. Researchers are investigating the role of foods, chemicals, stress, and even microbiota in the development of autoimmune disorders like celiac disease.
Until the middle of the 20th-century, researchers viewed various autoimmune diseases as entirely different conditions. So, they did not see anything common between type 1 diabetes, rheumatoid arthritis, or celiac, as they all have very different symptoms and organ involvement.
Microbiota- its role in immunity, autoimmunity,and inflammatory responses
The role of microbiota, which is microbes that live in our body, has received a lot of attention. These microbes help our body in various ways; they produce useful substances (symbiosis), help to fight invading pathogens, an they also play a role in maintaining self-tolerance and preventing autoimmune diseases, playing a critical role in overall health. Gut microbiota has been studied intensively for its role in regulating immune balance.
It is thought that microbiota plays a vital role in the induction, training, and working of the immune system. But, the evolution of microbes and even with nematodes has been suddenly disrupted with extensive use of disinfectants, anthelminthic drugs, antifungals, and antibiotics/antibacterial drugs. The eradication of these, mostly, beneficial bacteria has resulted in alterations in immune responses. Our body has lost many helpful partners in health. Although the subject is complex and the role of these symbiotic organisms is poorly understood, it is thought that their eradication is among one of the factors involved in an upsurge of autoimmune diseases, and even a particular kind of immune defects and allergies.
There is an opinion that autoimmune diseases are more common than what was thought earlier. Some of the thought leaders in the field feel that autoimmune disorders due to the disturbances of microbiota touch almost everyone to some extent.
Latest research did not show relationship between childhood antibiotic use and type 1 diabetes or celiac disease
One of the subjects that has received lots of attention is the use of antibiotics at an early age. Most of the beneficial microbes establish themselves during the early days of our life. After the birth, many adjustments happen between microscopic residents of our body, and immune system, as they start to know each other better, begin helping each other. Some researchers think that many of the autoimmune diseases may be the result of the use of antibiotics in these early stages of life when the partnership between microbes and the immune system is still taking shape.
However, scientists have not made much progress in finding the link between the use of antibiotics in early life and development of autoimmune disease later in life. One of the latest research papers published in the journal JAMA Pediatrics did not confirm any relationship.
In the study, Kemppainen et al. from the University of Florida analyzed the data gathered during the clinical trial done earlier called The Environmental Determinants of Diabetes in the Young (TEDDY) study. It was the study that looked at various environmental determinants that may lead to diabetes in young children, including the use of antibiotics. Considering that autoimmune diseases are linked to each other, it was expected that the utility of this study would not be limited to understanding diabetes.
In the study (TEDDY), 8495 children tested positive for islet autoantibodies (responsible for type 1 diabetes), and 6558 children tested positive for transglutaminase autoantibodies (an indicator of developing celiac disease). The study fixed 38,152 instances of antibiotic use, which is one of the most extensive studies in this direction.
Some of the most commonly used antibiotics in the children were beta-lactams and macrolides. 42.3 percent children were prescribed amoxicillin to treat ear infections (otitis media). Macrolides and beta-lactams were prescribed in more than 70 percent of cases (of antibiotic use) in the first 48 months of life.
5.5 percent of the children developed islet antibodies before 50 months, and the median age of seroconversion was just 21.4 months. Whereas, most tested positive for multiple islet antibodies before the age of 24.3 months. However, thest udy did not show any relationship between the development of islet autoantibodies and the use of antibiotics during the first or second year of life.
Similarly, the presence of celiac disease autoimmunity was detected in 11.9 percent of children before the age of 50 months. The average age for seroconversion was 30.6 months. Here also, no link was found between celiac disease and antibiotic prescription during the first two years of life.
The study concluded that at least the use of antibiotics during the first two years of life has nothing to do with the development of type 1 diabetes or celiac disease in the later life. Researchers say that based on this study one can say that the benefits of antibiotic therapy in young age outweigh any assumed risk.
It is not to say that the microbiome has nothing to do with autoimmune disorders, but this study does prove the safety of some of the conventional antibiotics, and their use to treat infections
- Kemppainen KM, Vehik K, Lynch KF, et al. Association Between Early-Life Antibiotic Use and the Risk of Islet or Celiac Disease Autoimmunity. JAMA Pediatr. 2017;171(12):1217-1225. doi:10.1001/jamapediatrics.2017.2905
- Schmidt CW. Questions Persist: Environmental Factors in Autoimmune Disease. Environ Health Perspect. 2011;119(6):A248-A253.
- Belkaid Y, Hand TW. Role of the Microbiota in Immunity and Inflammation. Cell. 2014;157(1):121-141. doi:10.1016/j.cell.2014.03.011
- Role of the Microbiota in Immunity and Inflammation. Cell. 2014;157(1):121-141. doi:10.1016/j.cell.2014.03.011
- Wu H-J, Wu E. The role of gut microbiota in immune homeostasis and autoimmunity. Gut Microbes. 2012;3(1):4-14. doi:10.4161/gmic.19320