Ask Dr. Weir - February 2021
This month’s “Ask the Expert” features Dr. Dascha Weir, MD, Associate Director, The Celiac Disease Program, Boston Children’s Hospital. Dr. Weir answers questions about how children react to an accidental gluten exposure and when children can be vaccinated for COVID-19.
Question - Recently my daughter was accidently exposed to gluten. When she was first diagnosed with celiac disease her response to gluten was vomiting. After this recent exposure her response was a headache and fatigue. Is it normal for your reaction to gluten to change?
Dr. Weir - In people with celiac disease, there is a wide range of symptoms triggered by ingestion to gluten. Some people with celiac disease have severe to mild gastrointestinal symptoms when they are exposed to gluten, such as abdominal pain, nausea, vomiting or changes in their stool pattern (diarrhea or constipation). Others may have non-gastrointestinal symptoms, such as irritability, fatigue, headaches or joint pains. Some will have no recognizable symptoms when they ingest gluten.
Interestingly, an individual with celiac disease can also have a range of symptoms with gluten ingestions. Some of this variation is dependent on the amount of gluten consumed. For example, a child may develop abdominal pain after eating food that contains small amounts of gluten secondary to cross contact. But, that same child, may experience vomiting if they were to ingest a larger load of gluten in the form of a bowl of gluten containing pasta.
Many people with celiac disease seem to have a reproducible and recognizable reaction to gluten ingestion over time. However, we have observed that some children, as they get older, will have a shift in their symptom pattern with gluten exposures.
Question - When can we expect children to be eligible for the COVID-19 vaccine and will it be considered safe for kids with celiac disease?
Dr. Weir - Currently, the FDA has authorized use of two COVID-19 vaccines. One is currently approved for children 16 years of age and older. The other authorized vaccination is for people aged 18 years and older. Unfortunately, at this time, no COVID-19 vaccines have been approved for children under the age of 16 years.
The Society for the Study of Celiac Disease (SSCD) has released a statement on the safety of COVID-19 vaccination and specifically urges adults with celiac disease to get vaccination when it is offered to them. “As the safety and efficacy data on Covid vaccination has emerged, there is no evidence to suggest that people with celiac disease would be more prone to an adverse effect of vaccination. Celiac disease is not considered an allergy, and by itself does not prompt additional precaution when proceeding with vaccination”. You can read the entire statement here: https://www.theceliacsociety.org/sscd_news.
We encourage people with celiac disease over the age of 16 years of age to get COVID-19 vaccination when it becomes available to them. Vaccine eligibility varies state by state. Currently, in Massachusetts, teenagers who are 16 years of age and older who have 2 or more specific medical conditions (including cancer, chronic kidney disease, down syndrome, specific heart conditions, immunocompromised state from solid organ transplant, severe obesity, pregnancy, sickle cell disease, type 2 diabetes mellitus and moderate-to-severe asthma) are eligible for vaccination. Celiac disease is NOT a medical condition that qualifies at this time. It is not clear when vaccination eligibility will open up to all people older than 16 years.
While little is currently known about the safety and efficacy of COVID-19 vaccination in children, data is anticipated in the coming months. Clinical trials are currently underway in children 12 years and older and additional trials in children under the age of 12 will be initiated after results from the adolescent trials are in. Experts are hopeful that COVID-19 vaccination will be available to teenagers over the age of 12 in the fall of 2021. The timeline for vaccine authorization for children under the age of 12 is less clear but estimated to occur in early 2022.
If you would like to learn more about COVID-19 vaccines, please join the National Celiac Association (NCA) and the Harvard Medical School Celiac Research Program for “Get the Facts on COVID-19 Vaccines and Celiac Disease.” The second webinar in our “All Things Celiac” 2021 series will be held Thursday, March 25, 2021 at 1:00 pm EST. Speakers will present on selected topics for 60 minutes, followed by 15 minutes for Q&A.
Addressing the COVID-19 pandemic requires understanding variations in the human immune system, how different groups are affected by the virus, and how we can leverage science to develop targeted vaccines to protect us. Dr. Ofer Levy, director of the Precisions Vaccine Program in the Division of Infectious Diseases at Boston Children’s Hospital and Dr. Lael Yonker, pediatric pulmonologist and co-founder of the Pediatric COVID-19 Biorepository at Massachusetts General Hospital, will lead the discussion to help attendees understand what is known about the COVID-19 virus today and how new developments will help to contain community spread of the virus.