In the Journals

Vaccine skepticism common among patients with celiac disease, gluten sensitivity

Benjamin Lebwohl, MD
Benjamin Lebwohl

New survey results revealed that many patients with celiac disease or non-celiac gluten sensitivity avoid vaccines and believe they contain unsafe levels of gluten.

Notably, gluten sensitive patients were more likely than those with celiac disease to doubt vaccine safety and report other beliefs that conflict with conventional medical science.

“We performed this study because we wanted to better understand the health beliefs of people with celiac disease and non-celiac gluten sensitivity, particularly regarding beliefs that are not shared by conventional medicine,” Benjamin Lebwohl, MD, MS, director of clinical research at the Celiac Disease Center at Columbia University, told Healio Gastroenterology and Liver Disease. “For instance, we asked respondents about whether gluten is bad for everyone, about the safety of Cheerios, and about GMO foods, among other topics. But the most surprising finding was regarding vaccines. A significant number of respondents declined the flu vaccine, and also reported hearing or reading that vaccines may contain gluten.”

Lebwohl and colleagues evaluated web survey responses from 1,291 patients with celiac disease and 217 patients with non-celiac gluten sensitivity on the Celiac Disease Center’s email list (mean age, 50.7 years; 83.3% women).

Overall, 12.4% of respondents said they read or had been told that vaccines may contain gluten. Further, 41.3% of gluten sensitive patients and 26.4% of patients with celiac disease disagreed that vaccines are safe for people with celiac disease (P < .0001), and 30.9% vs. 24.2% declined vaccination when offered (P = .007).

“Those with non-celiac gluten sensitivity were more likely than those with celiac disease to decline the flu vaccine and to disagree with the statement that vaccines are safe for people with celiac disease,” Lebwohl said. “In fact, vaccines are safe for people with celiac disease, and there is no risk of gluten exposure when receiving a vaccine. The origin of this belief is unknown, but may stem from the longstanding concern about hidden sources of gluten exposure, from condiments to supplements. A lack of reliable information regarding the gluten-free status of medications may have spilled over into the false belief that vaccines contain gluten. This belief may lead to behavior that is harmful to public health and so we must counter this belief with facts and evidence.”

The survey results also showed that compared with patients with celiac disease, significantly more gluten-sensitive patients reported having an adverse reaction to gluten-free Cheerios (52.8% vs. 36.8%; P = .003), avoided genetically modified foods (GMOs; 47% vs. 27.8%; P < .0001), tried to eat only organic foods (28.6% vs. 12.2%; P < .0001), believed a gluten-free diet improves energy and concentration (40.3% vs. 20.7%; P < .0001), believed that gluten is bad for everyone (31.3% vs. 16.3%; P < .0001), and doubted the reliability of the FDA (27.4% vs. 17.2%; P = .0012).

Multivariate analysis adjusting for age and sex confirmed that gluten sensitive patients were more likely than those with celiac disease to avoid GMOs (aOR = 2.3; 95% CI, 1.71-3.1), only eat organic products (aOR = 2.87; 95% CI, 2.04-4.03), doubt information provided by the FDA (aOR = 1.82; 95% CI, 1.26-2.64) and believe that a gluten-free diet improves energy and concentration (aOR = 2.52; 95% CI, 1.86-3.43). They were also less likely than those with celiac disease to believe that vaccines were safe (aOR = 0.51; 95% CI, 0.37-0.69) and less likely to experience mostly diarrhea after being exposed to gluten (aOR = 0.47; 95% CI, 0.27-0.82).

As we recently reported, the FDA just released a draft guidance with new recommendations for labeling gluten in medications.

“Furthermore, the role of health beliefs in the pursuit of the rigorous gluten-free diet in [non-celiac gluten sensitivity] needs to be further explored in order to optimize care for this unique patient population,” Lebwohl and colleagues added. – by Adam Leitenberger

Disclosures: The authors report no relevant financial disclosures.

Benjamin Lebwohl, MD
Benjamin Lebwohl

New survey results revealed that many patients with celiac disease or non-celiac gluten sensitivity avoid vaccines and believe they contain unsafe levels of gluten.

Notably, gluten sensitive patients were more likely than those with celiac disease to doubt vaccine safety and report other beliefs that conflict with conventional medical science.

“We performed this study because we wanted to better understand the health beliefs of people with celiac disease and non-celiac gluten sensitivity, particularly regarding beliefs that are not shared by conventional medicine,” Benjamin Lebwohl, MD, MS, director of clinical research at the Celiac Disease Center at Columbia University, told Healio Gastroenterology and Liver Disease. “For instance, we asked respondents about whether gluten is bad for everyone, about the safety of Cheerios, and about GMO foods, among other topics. But the most surprising finding was regarding vaccines. A significant number of respondents declined the flu vaccine, and also reported hearing or reading that vaccines may contain gluten.”

Lebwohl and colleagues evaluated web survey responses from 1,291 patients with celiac disease and 217 patients with non-celiac gluten sensitivity on the Celiac Disease Center’s email list (mean age, 50.7 years; 83.3% women).

Overall, 12.4% of respondents said they read or had been told that vaccines may contain gluten. Further, 41.3% of gluten sensitive patients and 26.4% of patients with celiac disease disagreed that vaccines are safe for people with celiac disease (P < .0001), and 30.9% vs. 24.2% declined vaccination when offered (P = .007).

“Those with non-celiac gluten sensitivity were more likely than those with celiac disease to decline the flu vaccine and to disagree with the statement that vaccines are safe for people with celiac disease,” Lebwohl said. “In fact, vaccines are safe for people with celiac disease, and there is no risk of gluten exposure when receiving a vaccine. The origin of this belief is unknown, but may stem from the longstanding concern about hidden sources of gluten exposure, from condiments to supplements. A lack of reliable information regarding the gluten-free status of medications may have spilled over into the false belief that vaccines contain gluten. This belief may lead to behavior that is harmful to public health and so we must counter this belief with facts and evidence.”

The survey results also showed that compared with patients with celiac disease, significantly more gluten-sensitive patients reported having an adverse reaction to gluten-free Cheerios (52.8% vs. 36.8%; P = .003), avoided genetically modified foods (GMOs; 47% vs. 27.8%; P < .0001), tried to eat only organic foods (28.6% vs. 12.2%; P < .0001), believed a gluten-free diet improves energy and concentration (40.3% vs. 20.7%; P < .0001), believed that gluten is bad for everyone (31.3% vs. 16.3%; P < .0001), and doubted the reliability of the FDA (27.4% vs. 17.2%; P = .0012).

Multivariate analysis adjusting for age and sex confirmed that gluten sensitive patients were more likely than those with celiac disease to avoid GMOs (aOR = 2.3; 95% CI, 1.71-3.1), only eat organic products (aOR = 2.87; 95% CI, 2.04-4.03), doubt information provided by the FDA (aOR = 1.82; 95% CI, 1.26-2.64) and believe that a gluten-free diet improves energy and concentration (aOR = 2.52; 95% CI, 1.86-3.43). They were also less likely than those with celiac disease to believe that vaccines were safe (aOR = 0.51; 95% CI, 0.37-0.69) and less likely to experience mostly diarrhea after being exposed to gluten (aOR = 0.47; 95% CI, 0.27-0.82).

As we recently reported, the FDA just released a draft guidance with new recommendations for labeling gluten in medications.

“Furthermore, the role of health beliefs in the pursuit of the rigorous gluten-free diet in [non-celiac gluten sensitivity] needs to be further explored in order to optimize care for this unique patient population,” Lebwohl and colleagues added. – by Adam Leitenberger

Disclosures: The authors report no relevant financial disclosures.