Gluten Free USTA Tennis Player Aces Sinus Infections!

Sinusitis Case Study:   A female USTA Tennis Player in her thirties, who enjoys playing doubles,  presented with a history of recurrent sinus and tonsil infections.  The subject’s  sinusitis frequently required multiple antibiotic doses to clear and some infections appeared unresponsive to therapy.   This subject experienced annual colds requiring antibiotic therapy.  She also experienced heartburn (gastro esophageal reflux disease (GERD)) which was treated with over the counter medications.  This tennis player began a wheat gluten free diet.

Fourteen years post wheat free diet initiation, this subject has experienced no sinus infections nor incidents of heartburn.   She  has experienced an occasional cold requiring the use of amoxicillin.  Upon exposure to wheat, rye, oats, or vegetation she has used over the counter anti-histamine therapy to prevent inflammation of her tonsils.  She avoids potatoes as they cause sinus congestion.  With continued avoidance of wheat products, her immune response to ingested wheat has become more pronounced.  During the past decade, wheat ingestion every two weeks would require antihistamines prior to and post ingestion to avoid inflammation of her tonsils and sinuses.  She continues on a wheat free diet with no sinus or tonsil  infections.

Sinusitis Discussion:

Normal respiratory epithelium contains cells resembling columns.  Many of these cells have brush-like hairs on their borders which are called cilia.  Goblet cells which secrete mucous are also present but they are rare.    Both the cilia and mucous help to move particles through respiratory structures.

In a pathologic disease process,  the structure of this respiratory epithelium changes.   When exposed to wheat germ agglutinin (WGA),  respiratory epithelial cells with sparce quantities of goblet cells are found to change into epithelium with heavy quantities of goblet cells secreting acid mucin.  These are the front line immune response defenders. It is theorized that the increase in mucous secretions could be a host defense mechanism meant to make bacterial adherence to tissue more difficult. Additional sialic and fucose residues are produced to immunologically conceal the mannose sugar and carbohydrate moieties from the  wheat germ, presumably disallowing attachment to the tissue.   The number of ciliated cells is reduced and the quantity of normal good bacterial flora present in the sinuses is decreasedThe resultant disease etiology is sinusitis and allergic rhinitis. 

Rhinitis and nasal allergies are frequently associated with Celiac Disease(CD). In a wheat challenge test of 23 bakers with a history of wheat flour induced ocular hypersensitivities, 17 subjects had symptoms of rhinitis within 10-30 minutes of wheat flour exposure (Wittczak, et al., Otori, et al. 1998).

Kaneko, et al. (2000) demonstrated that the use of wheat germ agglutinin showed that this lectin “strongly reacts with cilia and goblet cells”.  In a study of 258 baker’s apprentices, 54 developed IgE antibodies against wheat, rye and/or barley. The IgE antibodies developed in response to typical grass and pollen type allergies were found to correlate well with flour sensitization.  Radiographs were performed from these subjects and showed “mucosal thickening, opacity, air/fluid levels, and/or polypous shadowing” of the paranasal sinuses (Popp, et al. 1994).

Sinusitis References:

Wittczak,  “Challenge testing in diagonsis of occupational allergic conjunctivitis”  Occp Med 2007:57:532-534  DOI: 10.1093/occmed/kqm049

Otori N., Carlsoo  B., Stierna P.,  “Changes in Glycoconjugate Expression of the Sinus Mucosa during Experimental Sinusitis: A Lectin Histochemical Study of the Epithelium and Goblet Cell Development”, Acta Otolaryngol (Stockh) 1998; 118: 248-256

Popp W., Wagner C, Kiss D, Zwick, H, Sertl K, “Prediction of sensitization to flour allergens”, Allergy 1994; May; 49(5):376-9

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