Coeliac disease and spleen function
Adults (but very few children) with coeliac disease may have reduced spleen function (hyposplenism). The spleen is an organ in the body which plays an important role in the immune system. It controls the levels of blood cells and filters the blood to remove old or damaged blood cells. The risk of reduced spleen function in people with coeliac disease is recognised in the UK vaccination guidelines that your healthcare team will refer to (called the Green Book).
Something that isn’t clear in the Green Book is whether everyone with coeliac disease should have the vaccinations recommended for people with hyposplenism, or if only those who are known to have reduced spleen function should be vaccinated. Because of this uncertainty, we have asked the UK Government for further guidance. While we are waiting for more guidance, our Health Advisory Council have provided their guidance.
The guidance from our Health Advisory Council is for everyone with coeliac disease to be treated as potentially hyposplenic because although most people with coeliac disease will have normal spleen function, those individuals who do have reduced spleen function are typically not identified. For people with reduced spleen function, the Green Book recommends the pneumococcal vaccine should be given and a booster every five years. Because of the risk of hyposplenism, annual flu vaccination is also recommended. Vaccination against meningitis A,C,W,Y was introduced to the childhood immunisation programme in 2014. Our Health Advisory Council recommends that anyone born between 1995 and 2014 should speak with their GP about having the A,C,W,Y vaccination.
We are aware of proposed research to answer specific questions on hyposplenism, its actual frequency in people with coeliac disease, how best to assess this in practice and the response to vaccination in those with and without hyposplenism.
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Factors affecting the risk of hyposplensim
The risk of hyposplenism seems to depend on a number of factors and is lower for individuals who have been diagnosed and following a strict gluten free diet for several years and are otherwise healthy. These factors could be taken into account by your healthcare team when deciding whether you should be offered those vaccinations recommended for people with hyposplenism.