Asthma, Atopic Dermatitis, and Allergic Rhinitis in Pediatric Celiac Disease: A Case-control Study

Celiac disease is a gluten-induced immune-mediated enteropathy. Recent studies suggest an increasing association between celiac disease and atopic conditions such as asthma, atopic dermatitis, and allergic rhinitis, although the underlying mechanisms are not fully understood. In this matched case-control study, the prevalence of asthma, atopic dermatitis, and allergic rhinitis was evaluated among 173 children with celiac disease and 173 age- and sex-matched healthy controls in Zahedan, Iran, in 2023. The diagnosis of celiac disease was based on European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines. Allergic conditions were assessed using the International Study of Asthma and Allergies in Childhood questionnaire and confirmed through clinical evaluation. Children with celiac disease had a significantly higher prevalence of asthma (12.1% versus 5.8%; odds ratio, 2.25; 95% confidence interval, 1.15 to 4.05) and allergic rhinitis (29.5% versus 14.5%; odds ratio, 2.47; 95% confidence interval, 1.4 to 4.26) compared to controls. There was no significant difference in the prevalence of atopic dermatitis between the two groups (12.1% versus 9.2%; odds ratio, 1.35). These results indicate that children with celiac disease are at increased risk for certain respiratory allergic diseases, particularly asthma and allergic rhinitis. This highlights the need for integrated care between gastroenterology and allergy specialists. Further research is needed to clarify the shared immunological pathways involved.