There are over 80 different autoimmune diseases that impact the some 50 million Americans who live with one of those diseases. The causes of many autoimmune diseases are unknown, but genetics, infections, and the environment may play a part.
Unfortunately, there is generally no cure for autoimmune diseases; however, there are medications and lifestyle modifications that can help to manage the conditions.
Pharmacists can play an important role through an interdisciplinary approach in managing patients with autoimmune diseases. This article will focus on what pharmacists need to know about celiac disease.
- Jennifer Gershman, PharmD, CPh, drugtopics.com 1
Celiac Disease Management, Counseling Points, and Treatments on the Horizon
Celiac disease is an immune reaction, in the form of gastrointestinal (GI) symptoms, to eating gluten. There are different theories regarding the cause of celiac disease, which include genetics, GI infections, and stress; however, the exact cause is unknown. Approximately 1 in 100 individuals are diagnosed with celiac disease globally, and about 2.5 million Americans are undiagnosed, which can ultimately lead to long-term complications.
GI symptoms may include: diarrhea, weight loss, bloating and gas, abdominal pain, nausea and vomiting, and constipation. Celiac disease can also cause various non-GI symptoms, including: anemia, osteoporosis, skin rash, mouth ulcers, headaches, fatigue, nervous system problems, joint pain, and altered spleen function. Serology and genetic blood testing along with an endoscopy can help to diagnose celiac disease.
The gold standard for managing celiac disease is adhering to a gluten-free diet, as chronic inflammation can cause damage to the inner lining of the small intestine. Gluten is a protein found in wheat, barley, and rye. Additionally, the FDA specifies that food carrying “gluten-free” labels must contain less than 20 parts per million of gluten. However, even trace amounts of gluten can cause GI issues.
Pharmacists can play an important role in guiding patients to select appropriate gluten-free foods and medications. Educate patients to always read product packaging to ensure they are labeled as gluten-free or have no gluten-containing ingredients (Table). Patients may have questions about whether their medications contain gluten. Most drug products contain gluten-free starches (e.g., corn, potato, rice).
Medications won’t usually advertise the word gluten, so it’s important to focus on the ingredients which can be found through the product information on sites such as DailyMed, Gluten Free Drugs, or Pillbox. The drug manufacturer can also be contacted for additional information. If gluten is contained in an oral drug product, the amount is generally less than 0.5 mg per unit dose, which is considered less than a serving of gluten-free food.
Patients with celiac disease may require vitamin and mineral supplements (e.g., iron) if anemia or other nutritional deficiencies occur. Medications may be used to alleviate inflammation, which include steroids (e.g., budesonide) and immunosuppressive drugs (e.g., azathioprine). Dapsone may be used to treat the skin rash dermatitis herpetiformis, which can occur in patients with celiac disease. Pharmacists can educate patients that frequent blood tests are needed while receiving treatment with dapsone and immunosuppressive medications to monitor for adverse effects.
The use of text messaging was an effective intervention to improve patients’ quality of life according to a study published in the Journal of Pediatrics. It helped in their ability to manage their condition, work with healthcare providers, and prevent disease exacerbation. This may offer an effective technique for pharmacists and other members of the healthcare team to monitor diet adherence in patients with celiac disease.
There are currently no FDA-approved medication treatments for celiac disease. However, there is a promising drug in the pipeline, larazotide acetate, that has received fast track designation and belongs to a new class of drugs known as tight junction regulators. Larazotide works by decreasing inflammation in the intestine triggered by gluten, and it is currently in a phase 3 trial that is expected to enroll about 600 patients.