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Aetiology

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Pathogenetic factors include:

  • diet:
    • exposure to "prolamins", proteins rich in proline and glutamine
    • the most common cause is hypersensitivity to wheat gliadin; often the peptide corresponding to residues 31-47 is responsible
    • similarly antigenic proteins are found in barley, oats and rye

  • HLA type:
    • affected individuals show an increased frequency of histocompatibility antigens, A1, B8, and of haplotypes D3/DQw2 and D7/DQw2
    • a specific HLA DQ heterodimer is particularly closely linked to coeliac disease (A1*D0501 with B1*0201)

  • familial:
    • 70% concordance in monozygotic twins
    • 30% concordance in dizygotic twins who are HLA identical
    • 5-19% incidence in first degree relatives

  • time of first exposure to gluten:
    • early exposure may be a risk factor for coeliac disease
    • gluten should be avoided in the first six months of life

  • viral infection may trigger coeliac disease e.g. gluten shares sequence similarity with adenovirus 12

  • the autoantigen responsible for the anti-endomysial antibody activity is the enzyme transglutaminase

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