US Pharm. 2011;36(12):8.

The prevalence of celiac disease (CD), the inherited (in 5%-22% of patients) autoimmune disorder triggered by gluten, has increased an average of 2% to 3% annually since the 1950s, based on data from numerous studies to date. The odds of CD occurrence in people with first-degree relatives (parent, child, sibling) with CD is 1 in 22; in those with second-degree relatives (aunt, uncle, cousin) with CD, the prevalence rate decreases to 1 in 39, and the rate further decreases by 50% to 1 in 56 in people with related symptoms. CD affects more women than men, with a differential cost of 2 to 7 for women versus men, according to a 2010 estimate. Although it has been documented that 1 in 133 people (3 million) is affected by CD, a significant number (95%) of those affected do not know that they have CD or have not yet been diagnosed, due in part to the 4 to 8 years needed for correct diagnosis. With CD, the risk of developing other autoimmune and nonautoimmune disorders increases as well. The odds of developing an autoimmune disorder doubles as age at CD diagnosis increases from 4 years (i.e., 17% chance) to 20 years (i.e., 34% chance).

Comorbidities: Type 1 diabetes affects 3 million people, and 6% (180,000) of these patients also have CD. Down’s syndrome affects 350,000 people; 12% (42,000) of these also have CD. In studies, CD prevalence in patients with autoimmune thyroid disease is an average of 10-fold greater than in the control group. Clinical studies have tagged the development of osteoporosis (affecting 68% of women, or 44 million Americans) as a complication of untreated CD. Unexplained infertility, which affects 610,000 women in the United States, may be associated with CD in 6% (36,600) of them. Although no pharmaceuticals for cure of CD have been marketed, the National Institutes of Health lists 80 clinical trials that have been initiated since 2003, 47.5% of them in the active stage and another 37.5% completed (Phase I-III).

Management: Current practice calls for implementation of a gluten-free diet for disease-state management. Public awareness of CD has increased, contributing to billions of dollars in sales of gluten-free products. The food-label provisions detailed in the Food Allergen Labeling and Consumer Protection Act of 2004 enable CD patients to make informed decisions regarding food products. In 2004–2005, sales of gluten-free foods increased by 14.6%, and the U.S. Department of Agriculture estimates that the gluten-free industry generates nearly $2 billion in sales of the more than 2,000 gluten-free food items currently on the market.

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