D1.248 - Intersection of Autoimmune Mechanisms: Coexistence of Celiac Disease and Chronic Urticaria

Introduction: Celiac disease is an autoimmune enteropathy that develops in genetically predisposed individuals in response to gluten and may present with a wide range of gastrointestinal and extraintestinal manifestations. Chronic urticaria is an idiopathic condition characterized by recurrent pruritic and edematous wheals. The coexistence of celiac disease and chronic urticaria is rare.

Case Report: A 20-year-old female patient presented with pruritic, migratory urticarial lesions. Her medical history included a diagnosis of chronic urticaria and previous biological treatment with anti-IgE (omalizumab). Clinical evaluation revealed chronic diarrhea, abdominal pain, and abdominal distension. Laboratory investigations demonstrated iron and folate deficiency anemia. Serological tests for celiac disease were positive, and duodenal biopsy findings were consistent with celiac disease. Due to inadequate response to oral antihistamine therapy, omalizumab treatment was reinitiated. During follow-up, persistent urticarial lesions and pruritus necessitated an increased dose of omalizumab and the addition of immunosuppressive therapy with cyclosporine. After confirmation of celiac disease, a gluten-free diet was initiated. Following adherence to the gluten-free diet, significant clinical improvement was observed in both urticarial lesions and pruritus.

Conclusion: Celiac disease may rarely be associated with chronic urticaria. In patients with chronic urticaria accompanied by anemia and gastrointestinal symptoms, celiac disease should be considered in the differential diagnosis. This case represents a rare example of omalizumab-resistant chronic urticaria associated with celiac disease and underscores the importance of evaluating for celiac disease in patients with chronic urticaria when clinical suspicion is present.