ABSTRACT
Background: Alopecia areata is an autoimmune disease mediated by T-lymphocytes in which autoantigens play an important part in activating T-cells and is associated with other autoimmune diseases. Hair follicle is an immune-privileged site where major histocompatibility complex (MHC) Class I and II molecules are not expressed. Celiac disease (CD) is an autoimmune disorder that affects people who are genetically predisposed to develope an immune reaction to gluten. The small intestine is the primary site of CD.The clinical presentation, on the other hand, can be distinguished by both intestinal and extra-intestinal manifestations. Serological tests are initially recommended for the diagnosis of CD. One of the most sensitive and specific tests is anti-tissue transglutaminase IgA. Other serological tests include anti-gliadin IgA and IgG.
Aim of the Work: To evaluate serum level of antigliadin antibodies (Ig A and Ig G classes) in patients with alopecia areata and their relation to the severity of the disease.
Patients and Methods: This case control study included 60 participants including 30 patients with alopecia areata and 30 healthy individuals as controls. Patients were selected from Dermatology outpatient clinic in AL Zahraa University hospital during the period from November 2020 to April 2021.
Results: Out of 30 patients with alopecia areata included in the study the severity of alopecia tool score (SALT) score was S5 in 8 (26.7%) patients, S4 in 2 (6.7%), S3 in 1 (3.3%), S2 in 5 (16.7%) and S1 in 14 (46.7%). Antigliadin Ig A was only positive in 8 (26.7%) S5 patients while IgG was positive in all 30 patients with 2 positive cases in control group resembling (6.7%). There was statistically significant difference between control and patients groups regarding IgA and IgG levels, as higher values was found in patients than controls,the median (IQR) of Ig A in patients was 9.11 (6.88 – 12.2) while in control group was 1.56 (0.97 – 3.29)with p-value < 0.001. By ROC curve for sensitivity and specificity of IgA and IgG, we found that there were 100% sensitivity and specificity of IgA with cutoff point >4.25 and also for IgG with cutoff point >13.
Conclusion: There was a high statistically significant association between antigliadin antibodies (Ig A and Ig G class), and AA and its severity, with100% sensitivity and specificity of IgA with cutoff point >11.56 and also for IgG with cutoff point >41.8. An active search for CD using serological screening tests has been recommended to diagnose the numerous cases of subclinical CD in AA patients.