Autoimmune and gastrointestinal dysfunctions: Does a subset of children with autism reveal a broader connection?

Expert Review of Gastroenterology and Hepatology

Volumn 5, Issue 4, 2011, Pages 465-477

  Brown, Amy C ^a   Mehl Madrona, Lewis ^b  

^a UNIVERSITY OF HAWAII   (United States)

^b Union Institute and University   (United States)

Author keywords

abdominal distension; autism; autoimmune; constipation; diarrhea; food allergy; food sensitivity; gastrointestinal; genetic; permeable gut

Indexed keywords

IMMUNOGLOBULIN A; MYELIN BASIC PROTEIN;

ANTIBODY PRODUCTION; AUTISM; AUTOIMMUNE DISEASE; CD8+ T LYMPHOCYTE; CELIAC DISEASE; CHOLECYSTECTOMY; CONSTIPATION; COPY NUMBER VARIATION; CORRELATION ANALYSIS; CROHN DISEASE; ENVIRONMENTAL EXPOSURE; ENVIRONMENTAL FACTOR; FOOD ALLERGY; GALLSTONE; GASTROINTESTINAL DISEASE; GENETIC ASSOCIATION; GENETIC SUSCEPTIBILITY; HEREDITY; HUMAN; IMMUNOGLOBULIN BLOOD LEVEL; INNATE IMMUNITY; INTESTINE FLORA; INTESTINE MUCOSA PERMEABILITY; LYMPHOCYTE COUNT; MENTAL DEFICIENCY; NATURAL KILLER CELL; PREVALENCE; PROTEIN DEGRADATION; RETT SYNDROME; REVIEW; SEX DIFFERENCE; SYSTEMATIC REVIEW; T LYMPHOCYTE;

AUTISTIC DISORDER; AUTOANTIBODIES; AUTOIMMUNE DISEASES; BACTERIAL INFECTIONS; CHILD; FEMALE; FOOD HYPERSENSITIVITY; GASTROINTESTINAL DISEASES; HUMANS; MALE; PREVALENCE; SEX FACTORS; VIRUS DISEASES;

EID: 79960816787     PISSN: 17474124     EISSN: 17474132     Source Type: Journal    
DOI: 10.1586/egh.11.46     Document Type: Review

References (118)

1. Rapin I, Tuchman RF. Autism: definition, neurobiology, screening, diagnosis. Pediatr. Clin. North Am. 55(5), 1129-1146 (2008).
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th Edition).American Psychiatric Association, Washington, DC, USA (1994).
3. American Association of Pediatrics Council. Identification and evaluation of children with autism spectrum disorders. Pediatrics 120(5), 1183-1215 (2007)
4. White JF. Intestinal pathophysiology in autism. Exp. Biol. Med. 228(6), 639-649 (2003).
5. Autism and Developmental Disabilities Monitoring Network Surveillance year 2002 Principal Investigators; Centers for Disease Control and Prevention. Prevalence of autism spectrum disorders - autism and developmental disabilities monitoring network, 14 sites, United States, 2002. MMWR Surveill. Summ. 56, 12-28 (2007).
6. Giarelli E, Wiggins LD, Rice CE et al. Sex differences in the evaluation and diagnosis of autism spectrum disorders among children. Disabil. Health J. 3(2), 107-116 (2010).
7. El-Fishawy P, State MW. The genetics of autism: key issues, recent findings, and clinical implications. Psychiatr. Clin. North Am. 33(1), 83-105 (2010).
8. Muhle R, Trentacoste SV, Rapin I. The genetics of autism. Pediatrics 113(5), e472-e486 (2004).
9. Bailey A, Le Couteur A, Gottesman I et al. Autism as a strongly genetic disorder: evidence from a British twin study. Psychol. Med. 25(1), 63-77 (1995).
10. Costa e Silva J. Autism, a brain developmental disorder: some new pathopysiologic and genetics findings. Metabolism 57, S40-S43 (2008).
11. Rosenfeld JA, Ballif BC, Torchia BS et al. Copy number variations associated with autism spectrum disorders contribute to a spectrum of neurodevelopmental disorders. Genet. Med. 12(11), 694-702 (2010).
12. Hughes JR. Autism: the first firm finding = underconnectivity? Epilepsy Behav. 11, 20-24 (2007). (Pubitemid 47087189)
13. Pardo CA, Eberhart CG. The neurobiology of autism. Brain Pathol. 17(4), 434-447 (2007). (Pubitemid 47537607)
14. Lawler CP, Croen LA, Grether JK, Van de Water J. Identifying environmental contributions to autism: provocative clues and false leads. Ment. Retard. Dev. Disabil. Res. Rev. 10, 292-302 (2004). (Pubitemid 40209462)
15. Goodwin MS, Cowen MA, Goodwin TC. Malabsorption and cerebral dysfunction: a multivariate and comparative study of autistic children. J. Autism Child. Schizophr. 1(1), 48-62 (1971).
16. Comi AM, Zimmerman AW, Frye VH, Law PA, Peeden JN. Familial clustering of autoimmune disorders and evaluation of medical risk factors in autism. J. Child Neurol. 14(6), 388-394 (1999). (Pubitemid 29321099)
17. Atladoíttir HO, Pedersen MG, Thorsen P et al. Association of family history of autoimmune diseases and autism spectrum disorders. Pediatrics 124(2), 687-694 (2009).
18. Ashwood P, Van de Water J. Is autism an autoimmune disease? Autoimmun. Rev. 3(7-8), 557-562 (2004).
19. Ashwood P, Wills S, Van de Water J. The immune response in autism: a new frontier for autism research. J. Leukoc. Biol. 80(1), 1-15 (2006). (Pubitemid 44841805)
20. Careaga M, Van de Water J, Ashwood P. Immune dysfunction in autism: a pathway to treatment. Neurotherapeutics 7(3), 283-292 (2010).
21. Castellani ML, Conti CM, Kempuraj DJ et al. Autism and immunity: revisited study. Int. J. Immunopathol. Pharmacol. 22(1), 15-19 (2009).
22. Chez MG, Guido-Estrada N. Immune therapy in autism: historical experience and future directions with immunomodulatory therapy. Neurotherapeutics 7(3), 293-301 (2010).
23. Hornig M, Lipkin WI. Infectious and immune factors in the pathogenesis of neurodevelopmental disorders: epidemiology, hypotheses, and animal models. Ment. Retard. Dev. Disabil. Res. Rev. 7(3), 200-210 (2001). (Pubitemid 32843811)
24. Money J, Bobrow NA, Clarke FC. Autism and autoimmune disease: a family study. J. Autism Child. Schizophr. 1, 146 (1971).
25. Stubbs EG. Autistic children exhibit undetectable hemagglutination- inhibition antibody titers despite previous rubella vaccination. J. Autism Child. Schizophr. 6(3), 269-274 (1976).
26. Libbey JE, Coon HH, Kirkman NJ et al. Are there altered antibody responses to measles, mumps, or rubella viruses in autism? J. Neurovirol. 13(3), 252-259 (2007). (Pubitemid 47050651)
27. Weizman A, Weizman R, Szekely GA, Wijsenbeek H, Livni E. Abnormal immune response to brain tissue antigen in the syndrome of autism. Am. J. Psychiatry 139(11), 1426-1425 (1982).
28. Singh VK, Jensen RL. Elevated levels of measles antibodies in children with autism. Pediatr. Neurol. 28(4), 292-294 (2003). (Pubitemid 36802229)
29. Rout UK, Dhossche DM. A pathogenetic model of autism involving Purkinje cell loss through anti-GAD antibodies. Med. Hypotheses 71(2), 218-221 (2008).
30. Jepson B, Johnson J. Changing the Course of Autism. A Scientific Approach for Parents and Physicians. Sentient Publications, Boulder, CO, USA (2007).
31. Wills S, Cabanlit M, Bennett J, Ashwood P, Amaral D, Van de Water J. Autoantibodies in autism spectrum disorders (ASD).Ann. NY Acad. Sci. 1107, 79-91 (2007). (Pubitemid 47528784)
32. Li X, Chauhan A, Sheikh AM et al. Elevated immune response in the brain of autistic patients. J. Neuroimmunol. 207(1-2), 111-116 (2009).
33. Warren RP, Margaretten NC, Pace NC, Foster A. Immune abnormalities in patients with autism. J. Autism Dev. Disord. 16(2), 189-197 (1986). (Pubitemid 16116775)
34. Warren RP, Margaretten NC, Foster A. Reduced natural killer cell activity in autism. J. Am. Acad. Child Adolesc. Psychiatry 26(3), 333-335 (1987). (Pubitemid 17116696)
35. Trajkovski V, Ajdinski L, Spiroski M. Plasma concentration of immunoglobulin classes and subclasses in children with autism in the Republic of Macedonia: retrospective study. Croat. Med. J. 45(6), 746-749 (2004). (Pubitemid 40052932)
36. Vargas DL, Nascimbene C, Krishnan C, Zimmerman AW, Pardo CA. Neuroglial activation and neuroinflammation in the brain of patients with autism. Ann. Neurol. 57, 67-81 (2005). (Pubitemid 40053317)
37. Vojdani A, Mumper E, Granpeesheh D et al. Low natural killer cell cytotoxic activity in autism: the role of glutathione, IL-2 and IL-15. J. Neuroimmunol. 205(1-2), 148-154 (2008).
38. Heuer L, Ashwood P, Schauer J et al. Reduced levels of immunoglobulin in children with autism correlates with behavioral symptoms. Autism Res. 1(5), 275-283 (2008).
39. Santaella ML, Varela Y, Linares N, Disdier OM. Prevalence of autism spectrum disorders in relatives of patients with selective immunoglobulin A deficiency. P. R. Health Sci. J. 27(3), 204-208 (2008).
40. Kanner L. Autistic disturbances of affective contact. Nervous Child (Edition 2).In: Classic Readings in Autism. Donnellan AM (Ed.).Teacher's College Press, NY, USA, 217-250 (1985).
41. Konstantareas MM, Homatidis S. Ear infections in autistic and normal children. J. Autism Dev. Disord. 17(4), 585-594 (1987).
42. Niehus R, Lord C. Early medical history of children with autism spectrum disorders. J. Dev. Behav. Pediatr. 27(2 Suppl.), S120-S127 (2006). (Pubitemid 44620293)
43. Jyonouchi H, Geng L, Cushing-Ruby A, Quraishi H. Impact of innate immunity in a subset of children with autism spectrum disorders: a case control study. J. Neuroinflammation 5(1), 52 (2008).
44. Croen LA, Najjar DV, Ray GT, Lotspeich L, Bernal P. A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large group-model health plan. Pediatrics 118(4), e1203-e1211 (2006). (Pubitemid 46393771)
45. Gurney JG, Fritz MS, Ness KK, Sievers P, Newschaffer CJ, Shapiro EG. Analysis of prevalence trends or autism spectrum disorder in Minnesota. Arch. Pediatr. Adolesc. Med. 157(7), 622-627 (2003). (Pubitemid 36818640)
46. Kawashti MI, Amin OR, Rowehy NG. Possible immunological disorders in autism: concomitant autoimmunity and immune tolerance. Egypt J. Immunol. 13(1), 99-104 (2006) (Abstract).
47. van Gent T, Heijnen CJ, Treffers PD. Autism and the immune system. J. Child Psychol. Psychiatry 38(3), 337-349 (1997). (Pubitemid 27373343)
48. Shi L, Fatemi SH, Sidwell RW, Patterson PH. Maternal influenza infection causes marked behavioral and pharmacological changes in the offspring. J. Neurosci. 23(1), 297-302 (2003). (Pubitemid 36050430)
49. Shi L, Smith SE, Malkova N, Tse D, Su Y, Patterson PH. Activation of the maternal immune system alters cerebellar development in the offspring. Brain Behav. Immun. 23(1), 116-123 (2009).
50. Fatemi SH, Folsom TD, Reutiman TJ et al. Abnormal expression of myelination genes and alterations in white matter fractional anisotropy following prenatal viral influenza infection at E16 in mice. Schizophr. Res. 112(1-3), 46-53 (2009).
51. Fatemi SH, Reutiman TJ, Folsom TD et al. Maternal infection leads to abnormal gene regulation and brain atrophy in mouse offspring: implications for genesis of neurodevelopmental disorders. Schizophr. Res. 99(1-3), 56-70 (2008).
52. Brown AS, Derkits EJ. Prenatal infection and schizophrenia: a review of epidemiologic and translational studies. Am. J. Psychiatry 167(3), 261-280 (2010).
53. Atladoíttir HO, Thorsen P, Ostergaard L et al. Maternal infection requiring hospitalization during pregnancy and autism spectrum disorders. J. Autism Dev. Disord. 40(12), 1423-1430 (2010).
54. Meyer U, Nyffeler M, Engler A et al. The time of prenatal immune challenge determines the specificity of inflammation-mediated brain and behavioral pathology. J. Neurosci. 26(18), 4752-4762 (2006). (Pubitemid 44315314)
55. Dalton P, Deacon R, Blamire A et al. Maternal neuronal antibodies associated with autism and a language disorder. Ann. Neurol. 53(4), 533-537 (2003). (Pubitemid 36373267)
56. Warren RP, Cole P, Odell JD et al. Detection of maternal antibodies in infantile autism. J. Am. Acad. Child Adolesc. Psychiatry. 29(6), 873-877 (1990).
57. Zimmerman AW, Connors SL, Matteson KJ et al. Maternal antibrain antibodies in autism. Brain Behav. Immun. 21(3), 351-357 (2007). (Pubitemid 46199109)
58. Braunschweig D, Ashwood P, Krakowiak P, et al. Autism: maternally derived antibodies specific for fetal brain proteins. Neurotoxicology 29(2), 226-231 (2008).
59. Arvanitakis C. Abnormalities of jejunal mucosal enzymes in ulcerative colitis and Crohn's disease. Digestion 19(4), 259-266 (1979). (Pubitemid 9220598)
60. Ibrahim SH, Voigt RG, Katusic SK, Weaver AL, Barbaresi WJ. Incidence of gastrointestinal symptoms in children with autism: a population-based study. Pediatrics 124, 680-686 (2009).
61. Brown AC, Chow D, Murakami S et al. Possible gastrointestinal symptoms in a subset of children with autism. Expert Rev. Gastroenterol. Hepatol. 4(2), 125-127 (2010).
62. Black C, Kaye JA, Jick H. Relation of childhood gastrointestinal disorders to autism: nested case-control study using data from the UK General Practice Research Database. BMJ 325(7361), 419-421 (2002). (Pubitemid 34969792)
63. Kuddo T, Nelson KB. How common are gastrointestinal disorders in children with autism? Curr. Opin. Pediatr. 15(3), 339-343 (2003). (Pubitemid 36578087)
64. Pavone L, Fumara A, Bottaro G, Mazzone D, Coleman M. Autism and celiac disease: failture to validate the hypothesis that a link might exist. Biol. Psychiatry 42(1), 72-75 (1997). (Pubitemid 27293538)
65. Horvath K, Papadimitriou JC, Rabsztyn A, Drachenberg C, Tildon JT. Gastrointestinal abnormalities in children with autistic disorder. J. Pediatr. 135(5), 559-563 (1999). (Pubitemid 30180444)
66. Quigley EM, Hurley D. Autism and the gastrointestinal tract. Am. J. Gastroenterol. 95(9), 2154-2156 (2000).
67. Ahern WH. An assessment of food acceptance in children with autism or pervasive developmental disorder-not otherwise specified. J. Autism Dev. Disord. 31(5), 505-511 (2001).
68. Erickson CA, Stigler KA, Corkins MR, Posey DJ, Fitzgerald JF, McDougle CJ. Gastrointestinal factors in autistic disorder: a critical review. J. Autism Dev. Disord. 35(6), 713-727 (2005).
69. Schreck KA, Williams K. Food preferences and factors influencing food selectivity for children with autism spectrum disorders. Res. Dev. Disabil. 27(4), 353-363 (2006). (Pubitemid 44041130)
70. Schreck KA, Williams K, Smith AF. A comparison of eating behaviors between children with and without autism. J. Autism Dev. Disord. 34(4), 433-438 (2004). (Pubitemid 39127718)
71. Buie T, Campbell DB, Fuchs GJ III et al. Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics 125(Suppl. 1), S1-S18 (2010).
72. D'Eufemia P, Celli M, Finocchiaro R et al. Abnormal intestinal permeability in children with autism. Acta Paediat. 85(9), 1076-1079 (1996). (Pubitemid 26302768)
73. Lightdale JR, Hayer C, Duer A et al. Effects of intravenous secretin on language and behavior of children with autism and gastrointestinal symptoms: a single-blinded, open-label pilot study. Pediatrics 108(5), E90 (2001).
74. Levy SE, Souders MC, Ittenbach RF, Giarelli E, Mulberg AE, Pinto-Martin JA. Relationship of dietary intake to gastrointestinal symptoms in children with autistic spectrum disorders. Biol. Psychiatry 61(4), 492-497 (2007). (Pubitemid 46185339)
75. Valicenti-McDermott MD, McVicar K, Cohen HJ, Wershil BK, Shinnar S. Gastrointestinal symptoms in children with an autism spectrum disorder and language regression. Pediatr. Neurol. 39(6), 392-398 (2008).
76. Wakefield AJ, Murch SH, Anthony A et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 351(9103), 637-641 (1998). (Pubitemid 28098447)
77. Murch SH, Anthony A, Casson DH et al. Retraction of an interpretation. Lancet 363(9411), 750 (2004). (Pubitemid 38315163)
78. Wakefield AJ, Anthony A, Murch SH et al. Enterocolitis in children with developmental disorders. Am. J. Gastroenterol. 95(9), 2285-2295 (2000).
79. Torrente F, Anthony A, Heuschkel RB, Thomson MA, Ashwood P, Murch SH. Focal-enhanced gastritis in regressive autism with features distinct from Crohn's and Helicobacter pylori gastritis. Am. J. Gastroenterol. 99(4), 598-605 (2004). (Pubitemid 38607959)
80. Ashwood P, Anthony A, Torrente F, Wakefield AJ. Spontaneous mucosal lymphocyte cytokine profiles in children with autism and gastrointestinal symptoms: mucosal immune activation and reduced counter regulatory interleukin-10. J. Clin. Immunol. 24(6), 664-673 (2004). (Pubitemid 40933118)
81. Fasano A. Surprises from celiac disease. Sci. Am. 301(2), 54-61 (2009).
82. Turner JR. Intestinal mucosal barrier function in health and disease. Nat. Rev. Immunol. 9(11), 799-809 (2009).
83. Bjarnason I, MacPherson A, Hollander D. Intestinal permeability: an overview. Gastroenterology 110(3), 967-968 (1996).
84. Reichelt KL, Ekrein J, Sctoo H. Gluten, milk proteins and autism: dietary intervention effects on behavior and peptide secretion. J. Appl. Nutr. 42, 1-11 (1990).
85. Lucarelli S, Frediani T, Zingoni AM et al. Food allergy and infantile autism. Panminerva Med. 37(3), 137-141 (1995).
86. Brantl V, Teschemacher H, Bläsig J, Henschen A, Lottspeich F. Opioid activities of b-casomorphins. Life Sci. 28(17), 1903-1909 (1981).
87. Nyberg F, Lieberman H, Lindström LH, Lyrenäs S, Koch G, Terenius L. Immunoreactive b-casomorphin-8 in cerebrospinal fluid from pregnant and lactating women: correlation with plasma levels. J. Clin. Endocrinol. Metab. 68(2), 283-289 (1989). (Pubitemid 19052865)
88. Hemmings WA. The entry into the brain of large molecules derived from dietary protein. Proc. R. Soc. Lond. B Biol. Sci. 200(1139), 175-192 (1978). (Pubitemid 8278854)
89. Pankseep J. A neruochemical theory of autism. Trends Neurosci. 2, 174-177 (1979).
90. Lipkin WI, Hornig M. Microbiology and immunology of autism spectrum disorders. Novartis Found. Symp. 251, 129-143 (2003).
91. Bushara KO. Neurologic presentation of celiac disease. Gastroenterology 128(4 Suppl. 1), S92-S97 (2005). (Pubitemid 40460828)
92. Pynnonen PA, Isometsä ET, Verkasalo MA, Savilahti E, Aalberg VA. Untreated celiac disease and development of mental disorders in children and adolescents. Psychosomatics 43(4), 331-334 (2002).
93. Kalaydjian AE, Eaton W, Cascella N, Fasano A. The gluten connection: the association between schizophrenia and celiac disease. Acta Psychiatr. Scand. 113(2), 82-90 (2006). (Pubitemid 43340901)
94. Sandler RH, Finegold SM, Bolte ER et al. Short-term benefit from oral vancomycin treatment of regressive-onset autism. J. Child Neurol. 15(7), 429-435 (2000). (Pubitemid 30460223)
95. Whelan J. Antibiotics: a possible treatment for regressive-onset autism. Drug Discov. Today 5(11), 487-488 (2000).
96. Bolte ER. Autism and Clostridium tetani. Med. Hypotheses 51(2), 133-144 (1998). (Pubitemid 28381110)
97. Bohmer CJ, Taminiau JA, Klinkenberg-Knol EC, Meuwissen SG. The prevalence of constipation in institutionalized people with intellectual disability. J. Intellect. Disabil. Res. 45(Pt 3), 212-218 (2001). (Pubitemid 32591174)
98. Schwartzman F, Vitolo MR, Schwartzman JS, Morais MB. Eating practices, nutritional status and constipation in patients with Rett syndrome. Arq. Gastroenterol. 45(4), 284-289 (2008).
99. Afzal N, Murch S, Thirrupathy K, Berger L, Fagbemi A, Heuschkel R. Constipation with acquired megarectum in children with autism. Pediatrics 112(4), 939-942 (2003). (Pubitemid 37248705)
100. Lotan M, Ben-Zeev B. Rett syndrome. A review with emphasis on clinical characteristics and intervention. Sci. World J. 6(6), 1517-1541 (2006). (Pubitemid 44912696)
101. Percy AK, Lane JB. Rett syndrome: model of neurodevelopmental disorders. J. Child Neurol. 20(9), 718-721 (2005). (Pubitemid 41498703)
102. Prater CD, Zylstra RG. Medical care of adults with mental retardation. Am. Fam. Physician 75(5), 622, 624 (2007).
103. Levy J. The gastrointestinal tract in Down syndrome. Prog. Clin. Biol. Res. 373, 245-256 (1991).
104. Hilhorst MI, Brink M, Wauters EA, Houwen RH. Down syndrome and coeliac disease: five new cases with a review of the literature. Eur. J. Pediatr. 152(11), 884-887 (1993). (Pubitemid 23323004)
105. Bonamico M, Pasquino AM, Mariani P et al. Prevalence and clinical picture of celiac disease in Turner syndrome. J. Clin. Endocrinol. Metab. 87(12), 5495-5498 (2002). (Pubitemid 36034350)
106. Gillett PM, Gillett HR, Israel DM et al. Increased prevalence of celiac disease in girls with Turner syndrome detected using antibodies to endomysium and tissue transglutaminase. Can. J. Gastroenterol. 14(11), 915-918 (2000). (Pubitemid 32103391)
107. Gravholt CH. Clinical practice in Turner syndrome. Nat. Clin. Pract. Endocrinol. Metab. 1(1), 41-52 (2005).
108. Ivarsson SA, Carlsson A, Bredberg A et al. Prevalence of coeliac disease in Turner syndrome. Acta Paediatr. 88(9), 933-936 (1999). (Pubitemid 29448254)
109. Giannotti A, Tiberio G, Castro M et al. Coeliac disease in Williams syndrome. J. Med. Genet. 38(11), 767-768 (2001). (Pubitemid 33032932)
110. Rujner J, Wisniewski A, Gregorek H, Wozniewicz B, Mlynarski W, Witas HW. Coeliac disease and HLA-DQ 2 (DQA1. * 0501 and DQB1. *0201) in patients with Turner syndrome. J. Pediatr. Gastroenterol. Nutr. 32(1), 114-115 (2001). (Pubitemid 32094514)
111. Hill ID, Dirks MH, Liptak GS et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J. Pediatr. Gastroenterol. Nutr. 40(1), 1-19 (2005). (Pubitemid 40180049)
112. Stenberg R, Dahle C, Lindberg E, Schollin J. Increased prevalence of anti-gliadin antibodies and anti-tissue transglutaminase antibodies in children with cerebral palsy. J. Pediatr. Gastroenterol. Nutr. 49(4), 424-429 (2009).
113. Cohen WI. Current dilemmas in Down syndrome clinical care: celiac disease, thyroid disorders, and atlanto-axial instability. Am. J. Med. Genet. C Semin. Med. Genet. 142C(3), 141-148 (2006). (Pubitemid 44298196)
114. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 32(Suppl. 1), S13-S61 (2009).
115. Fasano A, Araya M, Bhatnagar S et al. Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition consensus report on celiac disease. J. Pediatr. Gastroenterol. Nutr. 47(2), 214-219 (2008).
116. Asperger H. Psychopathology of children with celiac disease. Ann. Paediatr. 197, 346-351 (1961).
117. Buie T, Fuchs GJ III, Furuta GT et al. Recommendations for evaluation and treatment of common gastrointestinal problems in children with ASDs. Pediatrics 125(Suppl. 1), S19-S29 (2010).
118. Brown AC, Roy M. Does evidence exist to include dietary therapy in the treatment of Crohn's disease? Expert Rev. Gastroenterol. Hepatol. 4(2), 191-215 (2010).