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Article

Wheat Consumption Leads to Immune Activation and Symptom Worsening in Patients with Familial Mediterranean Fever: A Pilot Randomized Trial

1
Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90124 Palermo, Italy
2
Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), University of Palermo, 90129 Palermo, Italy
3
Institute of Translational Immunology and Research Center for Immunotherapy, University Medical Center, Johannes Gutenberg University, 55122 Mainz, Germany
4
Surgery Department, University of Palermo, 90129 Palermo, Italy
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Hematology Unit for Rare Diseases, Laboratory of Molecular Genetic, Villa Sofia-Cervello, 90146 Palermo, Italy
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Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), University of Palermo, 90129 Palermo, Italy
7
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
*
Authors to whom correspondence should be addressed.
Nutrients 2020, 12(4), 1127; https://doi.org/10.3390/nu12041127
Received: 12 February 2020 / Revised: 15 April 2020 / Accepted: 15 April 2020 / Published: 17 April 2020
(This article belongs to the Special Issue Advance in Gluten-Free Diet)
We have identified a clinical association between self-reported non-celiac wheat sensitivity (NCWS) and Familial Mediterranean Fever (FMF). Objectives: A) To determine whether a 2-week double-blind placebo-controlled (DBPC) cross-over wheat vs. rice challenge exacerbates the clinical manifestations of FMF; B) to evaluate innate immune responses in NCWS/FMF patients challenged with wheat vs. rice. The study was conducted at the Department of Internal Medicine of the University Hospital of Palermo and the Hospital of Sciacca, Italy. Six female volunteers with FMF/NCWS (mean age 36 ± 6 years) were enrolled, 12 age-matched non-FMF, NCWS females, and 8 sex- and age-matched healthy subjects served as controls. We evaluated: 1. clinical symptoms by the FMF-specific AIDAI (Auto-Inflammatory Diseases Activity Index) score; 2. serum soluble CD14 (sCD14), C-reactive protein (CRP), and serum amyloid A (SSA); 3. circulating CD14+ monocytes expressing interleukin (IL)-1β and tumor necrosis factor (TNF)-α. The AIDAI score significantly increased in FMF patients during DBPC with wheat, but not with rice (19 ± 6.3 vs. 7 ± 1.6; p = 0.028). sCD14 values did not differ in FMF patients before and after the challenge, but were higher in FMF patients than in healthy controls (median values 11357 vs. 8710 pg/ml; p = 0.002). The percentage of circulating CD14+/IL-1β+ and of CD14+/TNF-α+ monocytes increased significantly after DBPC with wheat vs. baseline or rice challenge. Self-reported NCWS can hide an FMF diagnosis. Wheat ingestion exacerbated clinical and immunological features of FMF. Future studies performed on consecutive FMF patients recruited in centers for auto-inflammatory diseases will determine the real frequency and relevance of this association. View Full-Text
Keywords: AIDAI score; amylase trypsin inhibitor; non-celiac wheat sensitivity; CD14 lymphocytes; interleukin-1beta; tumor necrosis factor-α AIDAI score; amylase trypsin inhibitor; non-celiac wheat sensitivity; CD14 lymphocytes; interleukin-1beta; tumor necrosis factor-α
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MDPI and ACS Style

Carroccio, A.; Mansueto, P.; Soresi, M.; Fayer, F.; Di Liberto, D.; Monguzzi, E.; Lo Pizzo, M.; La Blasca, F.; Geraci, G.; Pecoraro, A.; Dieli, F.; Schuppan, D. Wheat Consumption Leads to Immune Activation and Symptom Worsening in Patients with Familial Mediterranean Fever: A Pilot Randomized Trial. Nutrients 2020, 12, 1127. https://doi.org/10.3390/nu12041127

AMA Style

Carroccio A, Mansueto P, Soresi M, Fayer F, Di Liberto D, Monguzzi E, Lo Pizzo M, La Blasca F, Geraci G, Pecoraro A, Dieli F, Schuppan D. Wheat Consumption Leads to Immune Activation and Symptom Worsening in Patients with Familial Mediterranean Fever: A Pilot Randomized Trial. Nutrients. 2020; 12(4):1127. https://doi.org/10.3390/nu12041127

Chicago/Turabian Style

Carroccio, Antonio, Pasquale Mansueto, Maurizio Soresi, Francesca Fayer, Diana Di Liberto, Erika Monguzzi, Marianna Lo Pizzo, Francesco La Blasca, Girolamo Geraci, Alice Pecoraro, Francesco Dieli, and Detlef Schuppan. 2020. "Wheat Consumption Leads to Immune Activation and Symptom Worsening in Patients with Familial Mediterranean Fever: A Pilot Randomized Trial" Nutrients 12, no. 4: 1127. https://doi.org/10.3390/nu12041127

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