Are those with Celiac Disease at Higher Risk of Severe Cases of COVID-19?

A recent article in The Atlantic had many in our community wondering about this question, so we reached out to experts for their comment.

From Ken Kilgore, PhD, MBA Beyond Celiac Chief Scientific Investment Officer

Certainly there are potential links between the mechanisms involved in celiac disease and COVID-19 immunity, which creates the possibility of increased response in those with celiac disease. However, this is purely hypothetical and has yet to be proven. At Beyond Celiac, we are closely monitoring the situation and will post any necessary updates on this page.

From Benjamin Lebwohl, MD, MS, Director of Clinical Research, The Celiac Disease Center at Columbia University

The bottom line is that we don’t have any direct evidence that people with celiac disease are at increased risk of developing severe consequences of COVID-19, but there is theoretical concern based on studies of other infections (including viral infections such as herpes zoster, an influenza). These prior studies show that people with celiac disease are at slightly increased risk of these conditions, or of more severe manifestations of these conditions. At the same time, it is reassuring that these increased risks are small, and so do not justify any additional precautions separate from those of the general population.

So my hope and expectation is that any increased risk of COVID-19 related complications in people with celiac disease, if present, will be very small. Certainly there’s no evidence to support additional precautions beyond what is advised to the general population at this time.

Data Collection Efforts

Since data about celiac disease and COVID-19 needs to be collected, we have introduced two new surveys in Go Beyond Celiac. One asks about the implications of COVID-19 on the celiac disease community whether or not they have been diagnosed. The other is specifically for people who have been diagnosed with COVID-19.

There is also an international effort to collect clinical data from physicians treating patients with celiac disease and COVID-19. That information is being collected here and is for physicians to fill out.

Are people with celiac disease “immunocompromised” and thus at higher risk of contracting coronavirus?

People with celiac disease who are otherwise healthy are not immunocompromised and not at higher risk for coronavirus. According to the CDC, people who are at higher risk are older adults and people with serious chronic medical conditions, such as heart disease, diabetes and lung disease. Currently, there is no evidence that children are more susceptible.

The immune system of someone with celiac disease activates in response to gluten when it shouldn’t. The immune system is over-active rather than suppressed. In contrast, the immune system of someone who is immunocompromised doesn’t react when it should. It is less effective at fighting off germs like those causing the flu and the coronavirus. Treatments such as chemotherapy, certain drugs for autoimmune conditions, steroids and some conditions (like AIDS), suppress the immune system’s response. Therefore, people with those conditions or taking those treatments are more at risk.

Under what conditions might a person with celiac disease be at elevated risk for coronavirus?

If you are taking corticosteroids and other immunosuppressant medications, you are at increased risk for coronavirus. While not typically used for celiac disease, these medications are often used to treat other autoimmune diseases.

The CDC says the data from China suggest that those with diabetes, heart disease, and lung disease are all at higher risk of getting more sick from coronavirus.

Would continued exposure to food containing gluten (accidental or voluntary) in people with diagnosed or undiagnosed celiac disease increase their susceptibility to COVID-19?

Acknowledging that there is no specific research data available, it follows that if celiac disease is carefully controlled and a strict gluten-free diet is in place, the immune system will have returned to a state similar to the rest of the population, and therefore the susceptibility to COVID-19 should not be different from that of the general population. If celiac disease is in its active stage, and a strict gluten-free diet is not observed (as in the case of those who are undiagnosed or those who continue to have accidental or intentional gluten exposure), the immune system is over-activated by the presence of gluten. Such over-activation of the immune system will make a person more susceptible to any viral infection, including COVID-19. Because more research is needed, we are collecting information about how COVID-19 impacts people with celiac disease through our Go Beyond Celiac database. With your feedback we can better understand the interplay between celiac disease and COVID-19 infection.