Abstract
Purpose. Immune system of some autistic patients could be abnormally triggered by gluten/casein assumption. The prevalence of antibodies to gliadin and milk proteins in autistic children with paired/impaired intestinal permeability and under dietary regimen either regular or restricted is reported. Methods. 162 ASDs and 44 healthy children were investigated for intestinal permeability, tissue-transglutaminase (tTG), anti-endomysium antibodies (EMA)-IgA, and total mucosal IgA to exclude celiac disease; HLA-DQ2/-DQ8 haplotypes; total systemic antibodies (IgA, IgG, and IgE); specific systemic antibodies: α-gliadin (AGA-IgA and IgG), deamidated–gliadin-peptide (DGP-IgA and IgG), total specific gliadin IgG (all fractions: α, β, γ, and ω), β-lactoglobulin IgG, α-lactalbumin IgG, casein IgG; and milk IgE, casein IgE, gluten IgE, -lactoglobulin IgE, and α-lactalbumin IgE. Results. AGA-IgG and DPG-IgG titers resulted to be higher in ASDs compared to controls and are only partially influenced by diet regimen. Casein IgG titers resulted to be more frequently and significantly higher in ASDs than in controls. Intestinal permeability was increased in 25.6% of ASDs compared to 2.3% of healthy children. Systemic antibodies production was not influenced by paired/impaired intestinal permeability. Conclusions. Immune system of a subgroup of ASDs is triggered by gluten and casein; this could be related either to AGA, DPG, and Casein IgG elevated production or to impaired intestinal barrier function.
Highlights
Autism and autism spectrum disorders (ASDs) are complex neurodevelopmental conditions [1,2,3,4]
Several studies suggest that autistic children could have an impaired gut barrier function as testified by an elevated intestinal permeability [5, 6]; the question if the intestinal barrier is impaired in ASD remains a debated question [7]
The impaired intestinal barrier function detected in ASD might predispose autistic children to sensitization to environmental antigens by allowing the passage of dietary-derived nonself antigens in the intestinal lamina propria, thereby triggering an immune response to these molecules [5, 6]
Summary
Autism and autism spectrum disorders (ASDs) are complex neurodevelopmental conditions [1,2,3,4]. It has been suggested that increased permeability of the gut and blood-brain barrier might be involved in the pathogenesis of these conditions [5]. Several studies suggest that autistic children could have an impaired gut barrier function as testified by an elevated intestinal permeability [5, 6]; the question if the intestinal barrier is impaired in ASD remains a debated question [7]. We have reported that intestinal permeability is increased in a large percentage of not-celiac autistic subjects and that it is partially corrected by gluten/casein-free diet regimen [8]. The fact that removing gluten from the diet may positively affect developmental outcome for some children with ASD suggests that autism may be part of the spectrum of not-celiac-gluten sensitivity (NCGS), at least in some cases
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