Gluten sensitivity based on HLA genotyping in patients with epilepsy in a tertiary hospital in Malaysia

Introduction Gluten sensitivity (GS) is present in approximately 1% of the Malaysian population (Yap et al., PLoS One, 10, 2015, e0121908). GS is associated with several neurological conditions including epilepsy. Individuals with GS often exhibit a genetic predisposition associated with human leukocyte antigens (HLA) (Cecilio & Bonatto, Arq Bras Cir Dig, 28, 2015, 183). The purpose of this study was to investigate the prevalence of GS based on HLA genotyping in patients with epilepsy (PWE). Method In total, 50 PWE and 50 controls were recruited. DNA was extracted from the venous blood samples and genotyped for HLA‐DQ2.2, DQ2.5, DQ7 and DQ 8. In this study, GS was diagnosed if any subject showed positive for one or more of the HLA‐DQ alleles. The type of epilepsy and number of antiseizure medication (ASM) used were recorded. Results Only 2 alleles (HLA‐DQ 2.2 & HLA‐DQ8) were detected among 46 out of 100 subjects. 18 PWE and 19 controls were positive for HLA‐DQ8 (p = 0.836). 9 of the PWE, but no controls were positive for HLA‐DQ 2.2 (p = 0.003). 8 of these 9 PWE who were positive for HLA‐DQ 2.2 were also positive for HLA‐DQ8 (double positive), and these patients required multiple ASM for seizure control (p = 0.006). Conclusion HLA‐DQ2.2 was seen highly prevalent in PWE. The double positives required more than one ASM for seizure control postulating malabsorption of ASM in these individuals. These findings suggest that HLA‐DQ genotyping may be a valuable additional test in PWE especially in those needing more than one ASM. Prescribing gluten‐free diet (GFD) to PWE with GS may potentially be an additional measure to achieve seizure control.