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World J Gastroenterol. Feb 14, 2013; 19(6): 838-845
Published online Feb 14, 2013. doi: 10.3748/wjg.v19.i6.838
Hepatitis B vaccine in celiac disease: Yesterday, today and tomorrow
Giovanna Vitaliti, Andrea Domenico Praticò, Carla Cimino, Giovanna Di Dio, Elena Lionetti, Mario La Rosa, Salvatore Leonardi
Giovanna Vitaliti, Andrea Domenico Praticò, Carla Cimino, Giovanna Di Dio, Elena Lionetti, Mario La Rosa, Salvatore Leonardi, Department of Pediatrics, University of Catania, 95100 Catania, Italy
Author contributions: All authors equally contributed to the building up of the paper, the literature bibliography research and to the writing of the paper.
Correspondence to: Salvatore Leonardi, MD, Department of Pediatrics, University of Catania, 95100 Catania, Italy. leonardi@unict.it
Telephone: +39-953-782764 Fax: +39-953-782385
Received: June 20, 2012
Revised: October 12, 2012
Accepted: October 16, 2012
Published online: February 14, 2013
Abstract

Some studies showed that in celiac patients the immunological response to vaccination is similar to that one found in general population except for vaccine against hepatitis B virus (HBV). The non-responsiveness to HBV vaccine has also been described in healthy people, nevertheless the number of non-responders has been demonstrated to be higher in celiac disease (CD) patients than in healthy controls. Several hypothesis explaining this higher rate of unresponsiveness to HBV vaccine in CD patients have been described, such as the genetic hypothesis, according with CD patients carrying the disease-specific haplotype HLA-B8, DR3, and DQ2, show a lower response to HBV vaccine both in clinical expressed CD patients and in healthy people carrying the same haplotype. On the other hand, it has been demonstrated that the gluten intake during the vaccination seems to influence the response to the same vaccine. Moreover, it has been demonstrated a possible genetic predisposition to hepatitis B vaccine non-responsiveness likely due to the presence of specific human leukocyte antigen haplotypes and specific single nucleotide polymorphism in genes of cytokine/cytokine receptors and toll like receptors, but the pathogenic mechanism responsible for this low responsiveness still remains unclear. The aim of this review is to focus on the possible pathogenic causes of unresponsiveness to HBV vaccine in CD patients and to propose an alternative vaccination schedule in order to improve the responsiveness to HBV vaccine in this at-risk patients.

Keywords: Celiac disease; Non responders; Hepatitis B vaccine; Vaccination schedules