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A rash and an upset gut? It could be coeliac disease

One of the first signs that you might have coeliac disease could very well be an itchy blistering skin rash.

Studies show that up to a quarter of coeliac sufferers have dermatitis herpetiformis which, to a lay person, looks much like many other types of dermatitis.

Even more telling, is that almost all sufferers of dermatitis herpetiformis seen by Hawke’s Bay specialist dermatologist Juber Hafiji turn out to have coeliac disease.

Named for its herpes-like blisters (but no relation), it can be intensely itchy and often affects the lower legs, forearms and buttocks.

The rash should not be taken lightly, Dr Hafiji says, because untreated coeliac disease can have long-term health consequences. And he knows from personal experience; having lived with coeliac disease for many years himself.

In simple terms, coeliac disease is an abnormal immune response to eating gluten, found in many foods including flours commonly used in baking. Severity can range from mild to debilitating, with symptoms including diarrhoea, nausea and vomiting, unexplained bruising, joint pain and muscle spasms, tiredness, mouth ulcers, hair and nail problems, and weight loss. The affect it has on the lining of the intestine can lead to vitamin deficiencies and, in serious cases, it can cause bone loss (osteoporosis) and increase the risk of cancer of the internal organs.

This week is Coeliac Disease Awareness Week [June 7 to 13], run by Coeliac New Zealand. It says international research indicates there could be up to 100,000 people in New Zealand with the disease (the most severe of a range of gluten intolerances), with a large proportion of them unaware they have it.

It typically occurs between the ages of 15 and 40, is twice as common in men as women, and is more usually suffered by Caucasians, compared to other races, says Dr Hafiji. “But really, it can affect any age or race.”

Dr Hafiji, as a coeliac disease sufferer, is acutely aware of the consequences.

As well has having the rash and intestinal problems, he suffered broken ribs in an “easy fall on grass” in his 30s, due to early onset osteoporosis. Given his Indian heritage and the severity of symptoms at a relatively young age, he has been part of an international research trial for a vaccine designed to “reset the immune system”.

But rather than wait for a vaccine or a cure, coeliac sufferers can use “the easy fix”, he says. “Strictly stay away from gluten and your problems will be solved.”

But in order to know to do that, first there needs to be a diagnosis. “The problem is that individually the symptoms – tiredness, a rash, stomach upset – might be any number of things. It takes detective work, but coeliac is certainly my starting point with dermatitis herpetiformis.”

The disease is confirmed using blood tests and skin biopsies. “The skin provides us with clues to internal problems, and that is certainly true with coeliac disease. I strongly recommend that people with this type of rash and gut symptoms have themselves tested for coeliac disease.”

For more information on coeliac disease and Coeliac Awareness Week, see: coeliac.org.nz