Background Gluten sensitivity refers to prominent immunological responses to gluten, usually in conjunction with elevated levels of serum antigliadin antibody (AGA). The association between AGA and cerebellar ataxias has been inconsistently reported.
Methods We performed a systematic literature search and a meta-analysis to study the weighted pooled OR of idiopathic cerebellar ataxia (IDCA) cases to controls or to hereditary ataxia (HA) for AGA seropositivity using fixed effect model.
Results Eleven studies were included, with a total of 847 IDCA cases, 1654 controls and 445 HA cases. IDCA cases had fourfold higher odds than controls (OR 4.28, 95% CI 3.10 to 5.90) and twofold higher odds than HA cases (OR 2.23, 95% CI 1.45 to 3.44) of having AGA seropositivity. Sensitivity analysis excluding the most weighted study, which accounted for 69% of the total weight, still showed similar associations (IDCA vs controls, OR 3.18, 95% CI 1.79 to 5.67 and IDCA vs HA, OR 1.72, 95% CI 1.03 to 2.86, respectively). The subgroup analysis showed that, when compared with controls, IDCA cases of both East Asian and Western countries had approximately threefold to fourfold higher odds to have AGA seropositivity (OR 3.41, 95% CI 1.67 to 6.97 and OR 4.53, 95% CI 3.16 to 6.49, respectively), suggesting the lack of ethnic heterogeneity. The odds of AGA seropositivity for HA cases was not significantly higher than controls (OR 1.41, 95% CI 0.82 to 2.44).
Conclusion Our study indicates the association between AGA and IDCA, across different geographic regions.
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Contributors C-YL: study concept, data acquisition, analysis and interpretation, manuscript draft and revision; M-JW: conducting meta-analysis, data analysis and interpretation and revision of the manuscript; WT: data acquisition and interpretation and critical revision of the manuscript for important intellectual content; RP: guidance and oversight on search strategy design and execution, preparation of results for screening and study selection processes, critical revision of the Methods section of the manuscript; AA: study concept, analysis and interpretation, critical revision of the manuscript for important intellectual content; PHRG: study concept, analysis and interpretation, critical revision of the manuscript for important intellectual content; S-HK: study concept, data acquisition, analysis and interpretation, critical revision of the manuscript for important intellectual content and study supervision.
Funding S-HK has received funding from the National Institutes of Health: NINDS #K08 NS083738 (principal investigator), and the Louis V Gerstner Jr. Scholar Award, Parkinson’s Foundation and International Essential Tremor Foundation.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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