Pneumococcal vaccination in celiac disease

ABSTRACT

Introduction: Celiac disease (CD) is an immune-mediated disorder associated with gluten exposure in genetically predisposed subjects.

Areas covered: Infectious disease is one of the causes of morbidity and mortality in CD patients. Invasive streptococcus pneumoniae (pneumococcus) is a particularly dangerous morbid condition in both the general population and celiac patients. Pneumococcal vaccination is the most effective means for its prevention.

Expert opinion: In CD, evaluation of spleen function should be useful to select patients who may benefit from vaccination to reduce the risk of pneumococcal disease. Different strategies could be employed: physicians could search for signs of hyposplenism on peripheral blood smear or abdominal ultrasound. However, the best strategy to identify which patients will benefit from pneumococcal vaccination has not yet been defined.

KEYWORDS:

• Celiac disease
• hyposplenism
• infections
• pneumococcal vaccination
• pneumonia

Article highlights

• Impairment of the immune function of the spleen results in a reduced number of IgM-memory B cells, the emergence of autoreactive T-cell clones, defective removal of pits from erythrocytes, and reduced platelet sequestration, with thrombocytosis

• Hyposplenism, a well-known risk factor for pneumococcal infection, is not routinely investigated and evaluated in celiac patients

• Every physician should investigate blood and/or ultrasound signs of hyposplenism and splenic atrophy in CD patients

• A systematic evaluation of spleen function should permit the selection of CD patients who may benefit from vaccination, in order to reduce the risk of invasive pneumococcal disease

• Celiac patients with impaired immunologic function need to undergo a complete vaccination protocol, including S. pneumoniae, N. meningitidis, H. influenzae type B, and influenza.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded.