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Flu Vaccine Misconceptions in Patients with Celiac Disease

May 25, 2017

Misconceptions about the gluten content of foods and vaccines may lead individuals with non-celiac gluten sensitivity and celiac disease to avoid protecting themselves against the flu, according to research headed by Benjamin Lebwohl, MD, MS, a gastroenterologist and an assistant professor of epidemiology at Columbia University.

Dr Lebwohl and colleagues explored the attitudes individuals with gluten-related digestive issues had toward the health effects of gluten, the safety of gluten-free products, and the safety of vaccines. The feedback they received through online surveys from 217 people with non-celiac gluten sensitivity and 1,291 people with biopsy-proven celiac disease showed these individuals might be putting themselves — and others — at risk by mistakenly believing that the influenza vaccine contains gluten.

Dr Lebwohl, who recently presented the study’s findings at the Digestive Disease Week 2017 (DDW) annual meeting in Chicago, discussed the potential negative consequences of that misconception and how healthcare providers can help change gluten avoiders’ attitudes toward protecting themselves against annual influenza.

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Why did you conduct this study?

As a celiac disease center, we see patients who seek our opinion about symptoms triggered by non-celiac gluten sensitivity, which is a condition we’re only now beginning to understand, especially with respect to its cause. That’s something that needs further study. We wanted to determine the attitudes, motivations, and concerns people with celiac disease and non-celiac gluten sensitivity have about the health effects of gluten and the overall safety of a gluten-free diet. We asked what the survey takers thought about this statement: Vaccines are safe for people with celiac disease.

What were the major findings?

We saw that 41% of the respondents with non-celiac gluten sensitivity disagreed, compared with 26% of the people with celiac disease. We were alarmed that concerns about vaccines exist. People with celiac disease or non-celiac gluten sensitivity can be safely vaccinated — there’s no actual reason for them to be concerned. Certainly questions persist among this patient population about the flu vaccine. We found that only a minority of individuals with celiac disease had been told the vaccines contain gluten. A substantial amount of the patients with celiac disease were uncertain that the flu vaccine is harmful, but patients with non-celiac gluten sensitivity were far more likely to decline the flu vaccine because of safety concerns. The study included highly educated individuals who had very different attitudes about the health properties of gluten. Among patients with celiac disease, a small minority believed gluten is bad for everyone. On the other hand, patients with non-celiac gluten sensitivity were much more likely to believe gluten causes everyone harm.

Why were individuals with non-celiac gluten sensitivity more skeptical of the vaccine’s safety?

We didn’t study that specifically, so any potential explanation is conjecture. One theory is that non-celiac gluten sensitivity isn’t explained in medical textbooks and patients with the condition might not trust conventional medicine, because doctors may have dismissed their health concerns in the past. Patients with non-celiac gluten sensitivity have ongoing digestive issues, and it’s often unclear if gluten or sensitivities to other foods trigger the symptoms. In our study, for example, 47% of patients with non-celiac gluten sensitivity who tried gluten-free Cheerios reported no adverse reaction, which suggested something other than the Cheerios caused their symptoms.

What message do healthcare providers need to take from the findings?

The flu vaccine is a benefit to public health and providers need to articulate the current understanding of the benefit and safety profiles of vaccines. They have an opportunity to improve public health by reaching one patient at a time to address their concerns and to keep them well informed and well educated about the benefits of influenza vaccination. It now appears that there is growing concern about vaccines containing gluten, even though that concern is not based on clinical evidence. Vaccines are safe for people with celiac disease and non-celiac gluten sensitivity. They need to know that.

Why is it important that people with celiac disease receive the influenza vaccine?

It’s believed that people with celiac disease suffer mild impairment to immune system function, so influenza infection can cause subsequent pneumonia. A study presented at DDW indicated people with celiac disease are at increased risk of pneumococcal infection and previous research has shown that individuals with celiac disease are more likely to be hospitalized for treatment of the flu. There’s no doubt healthcare providers need to stress the safety of the flu vaccine and promote its use among this population.

Dan Cook

Editor's note: This story has been updated to correct a typo in the sentence that previously stated "We saw that 41% of the respondents with non-celiac gluten sensitivity agreed, compared with 26% of the people with celiac disease." The word "agreed" has been corrected to "disagreed."

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