Published online Sep 18, 2016. doi: 10.4254/wjh.v8.i26.1105
Peer-review started: May 20, 2016
First decision: July 4, 2016
Revised: July 14, 2016
Accepted: July 29, 2016
Article in press: August 1, 2016
Published online: September 18, 2016
Processing time: 117 Days and 7.7 Hours
To evaluate hepatitis B virus (HBV) vaccine response and correlation with human leukocyte antigens (HLA) and/or gluten intake in celiac patients at diagnosis.
Fifty-one patients affected by celiac disease, diagnosed at the Department of Pediatrics of the University of Catania (Italy), were recruited. All patients were tested at admission for immunization against HBV, according to findings from analysis of quantitative HBV surface antibody (anti-HBs). The anti-HBs titer was measured by enzyme-linked immunosorbent assay. Following the international standards, subjects with antibody titer < 10 IU/L were defined as non-responders. The prevalence of responders and non-responders among celiac subjects and the distribution of immunization for age were examined. In addition, the prevalence of responders and non-responders was assessed for correlation to HLA and clinical features at diagnosis of celiac disease.
The entire study population was divided into three groups according to age: 24 patients aged between 0 to 5.5 years (48.9%, group A); 16 aged between 5.5 and 9.5 years (30.61%, group B); 9 aged between 9.5 and 17 years (18.75%, group C). Comparison of the percentage of responders and non-responders between the youngest and the oldest age group showed no significant difference between the two groups (P > 0.05). With regard to the HLA haplotype, comparison of the distribution of vaccination response showed no statistically significant difference between the different genotypes (homozygosity for the HLADQ2 haplotype compared with HLADQ2/DQ8 heterozygosity or other haplotypes; P > 0.05). Moreover, distribution of the responders according to clinical features of celiac disease showed no statistically significant differences (P > 0.05).
This prospective study confirmed the lower percentage of response to HBV vaccine in celiac subjects. However, the underlying mechanism remains unclear and further studies are needed.
Core tip: Correlation between celiac disease and lower response to hepatitis B virus (HBV) vaccine has been demonstrated, but the causes remain unclear. The lack of prospective data represents an extensive gap between the time of vaccination and development of the immune response, contributing to select “false non-responders” (i.e., those who are destined to lose the antibody titer over time). The originality of our prospective study is that of analyzing the response to HBV vaccine in a group of celiac patients at the time of diagnosis in an attempt to nullify the percentage of error related to confounding factors.