Can Early Infection in Infants Lead to Celiac Disease?

Large-Scale Research Suggests a Link

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For some time, experts have hypothesized that infections experienced during infancy—such as acute diarrhea or the common cold—could play a later role in the development of celiac disease. But, a recent study conducted in Germany may provide more concrete fodder to this claim.

Celiac disease is an immune disease in which a person can’t eat gluten because it will inflame and damage the small intestine. Symptoms are more common in children and include bloating, chronic diarrhea, stomach pain, and vomiting. Following a gluten-free diet, however, will usually curb any condition-related issues.

The Early Infection-Celiac Disease Link

Researchers analyzed the records of 295,420 infants born between 2005 and 2007 in Bavaria, Germany. They first identified the number of infections that occurred during the first year of life that required medical attention. Then they calculated the associated risk of being diagnosed with childhood celiac disease. The children were followed between birth and a median age of 8.5 years.

In total, 853 children developed celiac disease at a median age of five years. Of these children, 820 of them (95.5 percent) developed celiac disease after the first year of life. The researchers found that gastrointestinal—and to a lesser extent respiratory disease—increased the risk of later celiac disease. Furthermore, repeated gastrointestinal infections raised the risk even more.

In an earlier large population-based study, published in The American Journal of Gastroenterology, researchers assessed 72,921 Norwegian children between birth and a median age of 8.5 years. Similar to the German researchers, the Norwegian researchers discovered that there was a link between later celiac disease and infections experienced between birth and 18 months.

Potential Triggers & Other Considerations

To date, population-based research has shown only that a link between early infection and later celiac disease exists. The bigger question is how exactly does early infection trigger celiac disease. There are many possible ways that infection could contribute to celiac disease. Here are two hypotheses:

  1. Viruses may induce the production of pro-inflammatory proteins (interferons) and lead to the release of transglutaminase, an enzyme that plays an important role in the capability of gluten to provoke an immune response.
  2. Infection may increase the permeability of the gut lining thus allowing gluten to pass into circulation—an integral step in the development of celiac disease.

In all likelihood, several factors—not just infection—play a role in the development of celiac disease. For instance, in another recent study, following children from both the United States and Europe, researchers found that several things were implicated in the later development of celiac disease in addition to early gastrointestinal infection. These other factors are genetics, rotavirus vaccination status, age of first gluten consumption, and breastfeeding.

Notably, the researchers found that the risk for later celiac disease decreased when children who were genetically predisposed to celiac disease received the rotavirus vaccine and were introduced to gluten before six months of age. (Rotavirus vaccine protects against rotavirus, the major cause of diarrhea in babies and small children.)

A Word From Verywell

New large-scale research findings merely support that a link between early infection and celiac disease exists—not that this link is causal. In other words, although early infection and later celiac disease are tied, we don’t know if early infections actually cause celiac disease.

Some research seems to suggest that early rotavirus vaccination could possibly offer some protective benefits against celiac disease. Furthermore, early introduction of wheat bread or other forms of gluten could also reduce risk. At this point, we just don’t know enough to make a prediction. More research needs to be done.

Keep in mind that the CDC recommends that, by six months of age, all infants be vaccinated against rotavirus. After all, rotavirus can be dangerous, resulting in 60,000 hospitalizations in the United States each year. For now, the possibility that rotavirus vaccine could play some potential role in protecting a child from future celiac disease can be viewed as an added bonus. But, before introducing gluten into your baby’s diet, speak with your physician—especially if you have a family history of gluten intolerance.

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Article Sources
  • Beyerlein A, Donnachie E, Ziegler AG. Infections in early Life and development of celiac disease. Am J Epidemiol. 2017.
  • MedlinePlus. Celiac Disease.
  • Kemppainen, KM, et al. Factors That Increase Risk of Celiac Disease Autoimmunity After a Gastrointestinal Infection in Early Life. Clinical Gastroenterology and Hepatology 2017;15:694–702.
  • Mårild, K, et al. Infections and Risk of Celiac Disease in Childhood: A Prospective Nationwide Cohort Study.  Am J Gastroenterol. 2015; 110:1475–1484;