Can vaccination trigger Sweet’s syndrome?

Sweet’s syndrome triggered by vaccination.

There is some medical evidence to show that certain vaccinations can potentially trigger Sweet’s syndrome, but this is incredibly rare, and it is important to take the following information into consideration:

  • Sweet’s syndrome is rare, probably affecting no more than 3 people per 10,000 (Zamanian and Ameri, 2007).
  • It mainly affects adults not children, and only 5% to 8% of cases will be in children (Sharma et al, 2015).
  • In some people, something is needed to trigger the onset of Sweet’s syndrome, but in up to 71% of people with Sweet’s syndrome there is no known trigger (Tam and Ingraffea, 2015).
  • Infection, mainly upper respiratory tract infection, is a more common trigger for Sweet’s syndrome than vaccination. As a result, Sweet’s syndrome tends to be more common in countries where people are more likely to develop infections (Ginarte and Toribio, 2011:120).
  • There have only been 10 cases of Sweet’s syndrome triggered by vaccination reported in medical literature in the past 42 years – globally! In some of these cases, a definite connection between the vaccination and Sweet’s syndrome was not established.
  • Sweet’s syndrome has only been associated with certain vaccinations and not others (see below).

Which vaccinations have been associated with Sweet’s syndrome?

Sweet’s syndrome has been associated with the following vaccinations:

  • Bacillus Calmette-Guerin (BCG or tuberculosis) (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016). Two cases. One in 1986, occurring 15 days after vaccination, but the authors of the medical article that reported this did not control the tuberculin (Mantoux) test. One reported in 2002, occurring 10 days after vaccination.
  • Streptococcus pneumonia (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016; Pedrosa et al, 2013). Two cases. One reported in 1990, occurring 4 days after vaccination following a splenectomy. One reported in 2013, and the first with the 13-valent conjugate vaccine.
  • Smallpox (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016). Two cases reported in 1975, occurring 3 days after vaccination.
  • Influenza (Cruz-Velasquez et al, 2016; Hali et al, 2010, Jovanovic et al, 2005; Tan el al. 2006; Wolf et al. 2009). Four cases. One reported in 2005; in 2006, one case of bullous Sweet’s syndrome following vaccination in a HIV-infected patient; in 2009, neutrophilic dermatosis of the hands occurring 12 hours after vaccination; in 2010, one case of Sweet’s syndrome after H1N1 influenza (swine fluvaccination.

Do vaccinations trigger Sweet’s syndrome because they are toxic, contain toxins or dangerous chemicals?

No, vaccinations do not trigger Sweet’s syndrome because they are toxic, contain toxins or dangerous chemicals, and anyone who tells you this is either lying to you, trying to scare you, or has no understanding of vaccinations or Sweet’s syndrome.

Why do vaccinations trigger Sweet’s syndrome?

Vaccination can trigger Sweet’s syndrome because of hypersensitivity reaction. This is not the same as allergic reaction.

What is hypersensitivity reaction?

Sweet’s syndrome is caused by errors in the innate immune system (the body’s most primitive, ‘hard-wired’ immune system, and a part of the immune system that doesn’t produce antibodies). Because of these errors, in some people with Sweet’s syndrome, their innate immune system responds to antigens (proteins that a part of your immune system called the adaptive immune system sees as a foreign invader and produces antibodies in response to) in a way that it shouldn’t, i.e. is hypersensitive and over-reacts to the presence of infectious, inflammatory, drug, or tumour cell antigens (Bhat et al, 2015: 257; Kasirye et al, 2011: 135). This means that the presence of antigens associated with certain health conditions, medications and vaccinations can potentially trigger Sweet’s syndrome by causing the innate immune system to activate inflammatory cells, particularly white blood cells called neutrophils (Gosheger et al, 2002: 70). This then leads to the symptoms of Sweet’s syndrome.

If I have Sweet’s syndrome should I avoid having vaccinations?

No, most people with Sweet’s syndrome don’t need to avoid having their vaccinations unless they can’t be vaccinated for other medical reasons. However, if the Sweet’s syndrome was initially triggered by a particular vaccination, e.g. influenza, then it would not be advisable to have the same kind of vaccination again.

How do I know if vaccination has triggered my Sweet’s syndrome?

Remember, Sweet’s syndrome triggered by vaccination is incredibly rare, but if it does happen, then symptoms usually develop within hours, days or less commonly, a few weeks after vaccination. Skin lesions sometimes appear at the vaccination site, but this can also happen because of the skin damage caused by having the vaccination (puncture wound from the needle) rather than the vaccine itself. This response is known as pathergy.

Are there other triggers for Sweet’s syndrome?

Yes, and aside from the triggers that have already been mentioned (infection, skin damage, and vaccination), other triggers for Sweet’s syndrome include:

  • Cancer and blood disorders in 15-20% of cases, e.g. solid tumours, and myelodysplastic syndrome which may progress to acute myeloid leukaemia (Chen et al, 2016).
  • Inflammatory bowel disease, e.g. Crohn’s disease and ulcerative colitis (Cohen, 2007).
  • Autoimmune conditions, e.g. rheumatoid arthritis and systemic lupus erythematosus.
  • Medications in up to 5% of cases.
  • Pregnancy in up to 2% of cases. This is probably associated with hormonal changes, but further research is required.
  • Overexposure to sunlight or ultraviolet (UV) light. This can sometimes trigger Sweet’s syndrome, but we are not entirely sure why this happens.

References.

Bhat, Y., Hassan, I., Sajad, P., Akhtar, S. and Sheikh, S. (2015) Sweet’s Syndrome: An Evidence-Based Report. Journal of the College of Physicians and Surgeons – Pakistan, Jul;25(7):525-7 (PubMed).

Carpentier, O., Piette, F. and Delaporte, E. (2002) Sweet’s syndrome after BCG vaccination. Acta Dermato-Venereologica;82(3):221 (PubMed).

Chen, S., Kuo, Y., Liu, Y., Chen, B., Lu, Y. and Miser, J. (2016) Acute Myeloid Leukemia Presenting with Sweet Syndrome: A Case Report and Review of the Literature. Pediatrics and Neonatology (online).

Cohen, P. (2007) Sweet’s syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis (online).

Cruz-Velásquez, G., Pac Sha, J., Simal Gil, E. and Gazulla, J. (2016). Aseptic meningitis and anti-β2-glycoprotein 1 antibodies in Sweet syndrome. Neurologia (Barcelona, Spain), Jul 21 (0nline). Article in Spanish, use translate

Ginarte, M. and Toribio, J. (2011) Sweet Syndrome. In Dr. Fang-Ping (Ed.) Autoimmune Disorders – Current Concepts and Advances from Bedside to Mechanistic Insights. Croatia or China: Intech, pp. 119-132 (PDF). 

Gosheger, G., Hillman, A., Ozaki, T., Buerger, H. and Winklemann, W. (2002) Sweet’s Syndrome Associated With Pigmented Villonodular Synovitis. Acta Orthopædica Belgica, Feb;68(1):68-71 (PubMed).

Hali, F., Sbai, M., Benchikhi, H., Ouakadi, A. and Zamiati, S. (2010) [Sweet’s syndrome after H1N1 influenza vaccination]. Annales de Dermatologie et de Venereologie,  Nov;137(11):740-1 (PubMed).

Jovanovic, M., Poljacki, M., Vujanovic, L. and Duran, V. (2005) Acute febrile neutrophilic dermatosis (Sweet’s syndrome) after influenza vaccination. Journal of the American Academy of Dermatology, Feb;52(2):367-9 (PubMed).

Kasirye, Y., Danhof, R., Epperla, N. and Garcia-Montilla, R. (2011) Sweet’s Syndrome: One Disease, Multiple Faces. Clinical Medicine & Research, Nov;9(3-4):134-136 (online).

Pedrosa, A., Morais, P., Nogueira, A., Pardal, J. and Azevedo, F. (2013) Sweet’s syndrome triggered by pneumococcal vaccination. Cutaneous and Ocular Toxicology, Sep;32(3):260-1 (PubMed).

Sharma, A., Rattan, R., Shankar, V., Tegta, G. and Verma, G. (2015) Sweet’s syndrome in a 1-year-old child. Indian Journal of  Paediatric Dermatology;16:29-31 (online).

Tam, C. and Ingraffea, A. (2015) Case Letter: Sweet Syndrome Presenting With an Unusual Morphology. Cutis, Aug;96(2):E9-E10 (online).

Tan, A., Tan. H., and Lim, P. (2006) Bullous Sweet’s syndrome following influenza vaccination in a HIV-infected patient. International Journal of Dermatology, Oct;45(10):1254-5 (PubMed). 

Zamanian, A. and Ameri, A. (2007) Acute febrile neutrophilic dermatosis (Sweet’s syndrome): a study of 15 cases in Iran. International Journal of Dermatology, Jun;46(6):571-4 (PubMed).

Wolf, R., Barzilai, A. and Davidovici, B. (2009) Neutrophilic dermatosis of the hands after influenza vaccination. International Journal of Dermatology, Jan;48(1):66-8 (PubMed).

© 2012-2017 Sweet’s Syndrome UK

Mindfulness can reduce psychosocial distress in patients with conditions affecting the skin

What is mindfulness?

Taken from the UK mental health charity, MIND (MIND, 2016).

MIND describes mindfulness as:

‘ A technique which can help people manage their mental health or simply gain more enjoyment from life. It involves making a special effort to give your full attention to what is happening in the present moment – to what’s happening in your body, your mind or your surroundings, for example – in a non-judgemental way. Mindfulness describes a way of approaching our thoughts and feelings so that we become more aware of them and react differently to them.’

Can mindfulness help those with conditions affecting the skin to cope better?

Yes. A study by Montgomery et al has shown that mindfulness can help people ‘to reduce the distress associated with social anxiety and avoidance found in many skin conditions’ (Montgomery et al, 2016). This is very important, as those with conditions affecting the skin are at increased risk of developing anxiety and depression, often avoid social situations as a result of the distress that they cause, and can experience disability levels that are the same as those with other long term diseases.

Can anyone be mindful, and are there different ways to be mindful or practice mindfulness?

Yes. Anyone can be mindful, and there are many different ways in which you can practice mindfulness, e.g. by stopping to notice the small everyday things, by practising meditation or yoga, and by watching your thoughts or learning to view them in a different way (NHS Choices, 2016). For more information on how to be mindful, see ‘References’ below and click on the links.

References.

MIND (2016) Mindfulness (online).

Montgomery, K., Norman, P., Messenger, A. and Thompson, A. (2016) The importance of mindfulness in psychosocial distress and quality of life in dermatology patients. British Journal of Dermatology, Nov;175(5):930-936 (online).

NHS Choices (2016) Stress, Anxiety and Depression: Mindfulness (online). Includes information on the different ways in which you can be mindful.

Skin Support (2017) Support Materials. British Association Dermatologists (online). Includes ‘Meditations and Mindfulness’.

© 2012-2017 Sweet’s Syndrome UK

Baking soda is not a treatment for Sweet’s syndrome or myelodysplastic syndromes

Updated 26/01/17.

In 15-20% of patients with Sweet’s syndrome (SS), their condition develops secondary to some form of blood disorder or cancer, particularly a group of blood disorders called myelodysplastic syndromes (MDS). Depending on what type of MDS you have, MDS may cause problems such as anaemia (a low number of red blood cells) or more severe problems such as leukaemia (a type of blood cancer).

Is baking soda a treatment for Sweet’s syndrome or myelodysplastic syndromes?

No. Baking soda, otherwise known as sodium bicarbonate, is not a treatment for SS or MDS.

Recently, sodium bicarbonate has been advocated as a treatment for SS and/or MDS, including by Melissa Mendez who is a transformational nutrition coach with a website called The Pure Appeal (United States). She also has SS and MDS, but has no background in health care or science.

This idea that sodium bicarbonate is an effective treatment for SS and/or MDS is a potentially dangerous claim that is not supported by medical research, and if you have SS or/and MDS, you will need proper medical treatment. In some cases, if you do not receive proper medical treatment, this could result in you becoming seriously ill or even losing your life.

A doctor by the name of Tullio Simoncini is treating patients who have MDS and cancer with sodium bicarbonate. If he’s a doctor, doesn’t that mean it works?

No. Dr. Simoncini, who Melissa Mendez is a supporter of, is a former Italian doctor and known fraudster, and his practice is incredibly dangerous. In 2003, he was struck off the medical register for treating cancer patients with sodium bicarbonate instead of chemotherapy. In 2006, he was found guilty of fraud and manslaughter after a patient died as a result of using his treatments.

Unfortunately, Dr. Simoncini is continuing to tell people that MDS and cancer can be cured with sodium bicarbonate, despite the fact that there is no and has never been any medical research to support his claims. This pseudoscientific claim (false or made-up claim that appears to be scientifically based, but is not) is based on the idea that cancer is caused by Candida (fungus) or Candida albicans which causes the common fungal infection ‘thrush’, and that the body develops cancer in an attempt to protect itself from fungal infection. Sodium bicarbonate supposedly gets rid of the Candida and therefore cures the cancer. This is completely untrue. Cancer is not caused by Candida, and sodium bicarbonate isn’t even a treatment for fungal infections, let alone cancer.

Please treat anyone who advocates, promotes, sells or prescribes sodium bicarbonate as a treatment for MDS and leukaemia and other forms of cancer, with extreme caution. Also, remember that it is not a treatment for SS!

Is it true that an acidic diet can cause cancer, or that an alkaline diet can cure cancer or Sweet’s syndrome? Do I need to take baking soda to make my diet or body more alkaline?

On The Pure Appeal website (22/03/16), Melissa Mendez states that:

‘If baking soda can alter the ph of the body (make it more alkaline) to encourage healing, and it was clearly helping one of the rarest skin disorders (implying that it healed her Sweet’s syndrome), what does this mean for MDS?

Baking soda is almost like the magic bullet to jumpstart your body into full on healing mode. Cancers can not grow in an alkaline state. Even malignant tumors are incredibly acidic, so it only makes sense to go to the opposite end of the spectrum, if you want your body to heal.’

The information that Melissa Mendez has posted is inaccurate and makes no biological sense whatsoever. There is no evidence that an acidic diet can cause cancer or SS, or that an alkaline diet can cure cancer or SS or promote healing. The overall pH or potential hydrogen (pH tells us how acidic or alkaline a liquid is) of the body cannot be altered simply by changing your diet or adding things to it, i.e. make it more or less alkaline or acidic by consuming certain foods, substances or drinks. To begin with, your blood is slightly alkaline anyway, and this is tightly regulated by the kidneys which keep the pH within a normal and narrow range. The pH can’t be changed for any significant amount of time by what you consume, and any extra acid or alkali is simply peed out in urine. It is true that cancer cells are unable to live in a very alkaline environment, but neither can any other cells in the body. Therefore, if an alkaline diet did really have the ability to change the pH of your body, then it would probably kill you.

Even though you say that sodium bicarbonate isn’t a treatment for SS or/and MDS, if I want to try it, is it safe to use?

Sodium bicarbonate can be safe to use, and is commonly given as an antacid, i.e. to reduce stomach acid, but is sometimes used to treat other health conditions too. However, it is not always safe to use, particularly when taken in larger doses. This may be because of side-effects, certain health conditions or medications, pregnancy or breastfeeding. If given in high doses, the consequences may be serious or even fatal.

How is sodium bicarbonate given?

Sodium bicarbonate can be given orally (via the mouth), as an intravenous injection (injection into a vein), or as an intravenous infusion (into a vein via a drip). The way in which it is given depends on what kind of condition the sodium bicarbonate is being used to treat.

What are the side-effects of sodium bicarbonate?

Side-effects can depend upon how the sodium bicarbonate is given but may include:

  • Nausea.
  • Bloating.
  • Flatulence.

Less commonly:

  • Swelling of the hands, ankles and feet.
  • Sudden weight gain.

Rarely:

  • Dizziness.
  • Muscle aches and spasms.
  • Mental or mood changes, e.g. confusion, irritability or memory problems.
  • Vomiting.
  • General weakness.
  • Passing significantly more or less urine.
  • Chest pain.
  • Seizures.
  • When taken with lots of calcium (in the diet, medications or supplements), may cause milk-alkali syndrome.

In which health conditions should sodium bicarbonate be avoided or used with caution?

NOT TO BE USED in those with the following health conditions:

  • Certain breathing problems, e.g. pulmonary oedema.
  • Congestive heart failure.
  • Severe kidney disease.
  • Severe liver disease.
  • High sodium levels.
  • Swollen ankles, legs or feet due to retaining water (peripheral oedema).

To be used with CAUTION in those with:

  • Low calcium levels.
  • High blood pressure.
  • Heart problems.
  • Kidney disease.

Also, to be used with caution or avoided in those who are on a low-salt diet, pregnant or breastfeeding.

Which medications can be affected by sodium bicarbonate?

When taken orally in particular, sodium bicarbonate can interact with and should NOT BE USED if you are taking the following medications:

  • Aspirin and other salicylates, e.g. salsalate.
  • Barbiturates, e.g. phenobarbital.
  • Calcium supplements.
  • Corticosteroids (steroids), e.g prednisone.
  • Memantine.
  • Medications with a special coating to protect the stomach (enteric coating).
  • Lithium.
  • Quinidine.
  • Water pills (thiazide diuretics such as hydrochlorothiazide).

Reduces the effectiveness of and to be used with CAUTION when taking the following medications:

  • Certain drugs that require stomach acid to work, including ampicillin.
  • Atazanavir.
  • Certain azole antifungals (such as ketoconazole, itraconazole).
  • Iron supplements.
  • Pazopanib.
  • Sucralfate.

Sodium bicarbonate may also interact or reduce the effectiveness of some other medications, or should not be used in patients with health conditions that have not been listed above. Please speak to your doctor before use.

Additional note.

Sweet’s Syndrome UK does not promote the use of alternative or nutritional therapies. This is because there is no medical evidence to show that these therapies are effective, or sometimes even safe to use in those with Sweet’s syndrome. If anyone does have information that proves that alternative or nutritional therapies can be used to treat Sweet’s syndrome, I will be more than happy to read it. However, only peer-reviewed medical articles and case-studies will be accepted as evidence. The following will not be accepted as evidence: anecdotal evidence or personal stories; testimonials; YouTube videos; information on blogs or websites where there are no references or links to peer-reviewed medical articles or case-studies, or where the author is not willing to provide this information; blogs or websites where someone tries to pass off their feelings or instincts, beliefs or opinions as facts or evidence.

Thank you.

Michelle Holder.

Other information.

A warning about Polly Heil-Mealey! Sweet’s syndrome cannot be cured with herbs or homeopathic remedies.

Childs, O. (2014) Don’t Believe the Hype – 10 Persistent Cancer Myths Debunked. Cancer Research UK (online).

Chlorella is not a treatment for Sweet’s syndrome.

MDS UK Patient Support Group.

Smith, E. (2015) Alternative therapies: what’s the harm? Cancer Research UK (online). 

© 2012-2017 Sweet’s Syndrome UK

A wheat-free or gluten-free diet is not a treatment for Sweet’s syndrome

Currently being updated.

Is a wheat-free or gluten-free diet a treatment for Sweet’s syndrome?

It is not unusual for Sweet’s syndrome patients to be given inaccurate, bad or potentially harmful advice about their condition, particularly from non-health professionals. They can also find that they are pressurized into following a wheat-free or gluten-free diet, or some other kind of special diet as a treatment or cure for their Sweet’s syndrome. This is sometimes well-meant, but often, someone is just trying to promote their own agenda, or get people to buy a particular product or service.

Please be aware of the fact that there is absolutely no medical evidence to show that a wheat-free or gluten-free diet, or any other kind of special diet is a treatment or cure for Sweet’s syndrome. Be wary of anyone who makes such claims, particularly if they are trying to sell you something.

Do some patients with Sweet’s syndrome need to follow a wheat-free or gluten-free diet?

Yes. You will need to follow a 100% gluten-free diet if you have developed your Sweet’s syndrome secondary to the autoimmune condition, coeliac disease. This is because in order to bring the Sweet’s syndrome under control you need to manage or treat the underlying condition. However, Sweet’s syndrome developing secondary to coeliac disease is incredibly rare, and only one case has been reported in medical literature (Eubank et al, 2009).

What is coeliac disease?

When people with coeliac disease eat gluten, the surface of the small intestine becomes inflamed, and this affects the body’s ability to digest food. Management or treatment of coeliac disease includes a gluten-free diet, sometimes extra vaccinations and/or supplements, and less commonly, medication. See ‘Further information’ below to learn more.

Do patients with Sweet’s syndrome sometimes need to follow a wheat-free or gluten-free diet for other reasons?

Occasionally, someone with Sweet’s syndrome may need to follow a wheat-free or gluten-free diet for other types of condition that affect the bowel or gut, and a wheat-free diet will be necessary if you have a wheat allergy.

Can a wheat-free or gluten-free diet be harmful?

Eliminating wheat or gluten from your diet shouldn’t be harmful as long as you make sure that you are meeting all of your nutritional requirements. However, these diets aren’t suitable for everyone, and could potentially increase the risk of nutritional deficiency, e.g. calcium, iron, folic acid, or zinc deficiency, in some people. It is also advisable to check the nutritional content of gluten-free substitutes, e.g. bread or pasta, as they sometimes contain more fat or sugar than products containing gluten.


Frequently asked questions.

Question 1: Can a wheat-free or gluten-free diet be used to treat or cure Sweet’s syndrome and other autoinflammatory conditions?

No. Autoinflammatory conditions such as Sweet’s syndrome are not caused by diet, but errors in the innate immune system – the body’s most primitive, ‘hard-wired’ immune system. This then causes the immune system to activate inflammatory cells, often for unknown reasons, which leads to inflammation.

The majority of autoinflammatory conditions are genetic, which means that they occur as a result of gene mutation that affects how the innate immune system works. However, there are some, including Sweet’s syndrome, that are not usually genetic. In such cases, people are more likely to have certain genes that increase their risk of developing a particular autoinflammatory condition, i.e. they are genetically susceptible, but something may be needed to trigger it. Diet is not one of these triggers. Read about triggers for Sweet’s syndrome here.

Alongside genetic susceptibility, other causes for Sweet’s syndrome include hypersensitivity reaction and cytokine dysregulation.

Question 2: People with the autoimmune condition coeliac disease have to follow a gluten-free diet. My nutritional therapist told me that this means that all people with autoinflammatory conditions should be on a gluten-free diet too, even if they don’t have coeliac disease. Is this true?

No. Even though some autoinflammatory conditions, e.g. Sweet’s syndrome, can develop secondary to autoimmune conditions, autoinflammatory and autoimmune conditions are different. Also, gluten cannot play the same kind of role in autoinflammatory conditions as it does in the autoimmune condition, coeliac disease. This is because autoinflammatory conditions are not caused by diet, the wrong part of the immune system is involved, and there is no antibody production in response to certain naturally occurring proteins in the body. See below for further explanation.

Point 1.

Point 2.

  • In people with the autoimmune condition, coeliac disease, a part of the immune system called the adaptive immune system mistakes gliadin (a component of gluten) and tissue transglutaminase or tTG (a multifunctional enzyme or protein that also modifies gliadin so you can digest it) for foreign invaders such as a bacteria or virus. White blood cells called B-lymphocytes then make antibodies in response to the gliadin and tTG, and the antibody production in response to tTG in particular, causes inflammation and damage to the lining of the gut. Antibodies are also produced in response to endomysium (EMA) which is the protective covering of connective tissue that surrounds each individual muscle fibre. However, this does not cause direct symptoms to intestinal muscle.

Sometimes, Sweet’s syndrome can develop secondary to autoimmune conditions other than coeliac disease. However, just because those with coeliac disease have to follow a gluten-free diet, doesn’t mean that people with other autoimmune conditions will benefit from a gluten-free diet. This is because which proteins in the body are targeted will depend on what kind of autoimmune condition you have, e.g. antibodies will be produced in response to proteins other than tTG and EMA.

Point 3.

  • Autoinflammatory conditions involve the innate, and not the adaptive immune system. The innate immune system does not employ B-lymphocytes, and does not produce antibodies. Therefore, the inflammation in the bodies of patients with autoinflammatory conditions cannot be caused by the production of antibodies in response to tTG, EMA or gliadin.

Question 3: Is Sweet’s syndrome an allergic reaction to wheat?

No. Sweet’s syndrome is not an allergic reaction to wheat, and neither autoinflammatory nor autoimmune conditions are caused by allergy. See below for further information, and read Question 1 & 2.

Point 1.

  • The most common type of allergy is an IgE-mediated allergy. This is an adverse reaction that the body has to a particular substance that is foreign to the body, e.g. a food, pollen, or cat hair, that does not normally cause harm. This substance is known as an allergen (a type of antigen). Allergic reaction occurs when the immune system mistakes an allergen for a foreign invader such as a bacteria or virus. The adaptive immune system then quickly produces allergen-specific immunoglobulin E (IgE) antibodies in response to this, in order to fight the allergen off. Chemicals such as histamine are also produced, with the overall immune response causing the symptoms of allergy.
  • Another type of allergic reaction is a non-IgE-mediated allergy, which is believed to be T-cell mediated. This is an immune response that doesn’t involve antibodies and where white blood cells called T-lymphocytes (part of the adaptive immune system) are activated. The symptoms of this type of allergy can take much longer to develop than in IgE-mediated allergy, sometimes up to several days.

Point 2.

  • In autoinflammatory conditions, the innate and not the adaptive immune system is involved, and antibody production does not occur.

Point 3.

  • Despite antibodies being involved in both autoimmune conditions and IgE-mediated allergy, they are not the same thing. In IgE-mediated allergy, allergen-specific IgE antibodies are produced in response to something that is foreign to the body. In autoimmune conditions, antibodies are produced in response to naturally occurring proteins in the body, e.g. tTG and EMA in coeliac disease.

Question 4: I don’t have coeliac disease, but my friend told me that intolerance to gluten is probably causing my Sweet’s syndrome. Is this true?

No. Sweet’s syndrome or other autoinflammatory conditions are not caused by an intolerance to gluten.

What is gluten intolerance?

Gluten intolerance or non-coeliac gluten sensitivity (NCGS) is a sensitivity to gluten in people who do not have the autoimmune condition coeliac disease, and it is not the same as an allergy to wheat, or an autoinflammatory condition. In those who supposedly have NCGS, it causes intestinal and other symptoms as a result of eating foods containing gluten. There is ongoing debate over whether or not NCGS exists, and the stance of the NHS is that most people, unless they have coeliac disease, do not need to cut out gluten from their diet (NHS Choices, 2016).

If NCGS does exist, its exact nature is not fully understood for some of the following reasons:

  • The role of the immune system still remains unclear in NCGS (Catassi et al, 2013: 3849). The intestinal innate immune system seems to play an important role, but the research is ongoing.
  • It has not been determined whether or not symptoms of NCGS relate specifically or always relate to gluten, e.g. some people may be sensitive to other things in food that contain gluten, or have problems digesting certain types of carbohydrate.
  • A person may have irritable bowel syndrome (IBS) and not NCGS, an overlap in symptoms between the two conditions making diagnosis difficult (Catassi et al, 2013: 3841). IBS is a common, long-term condition of the digestive system. It can cause stomach cramps, bloating, diarrhoea and/or constipation. The exact cause of IBS is unknown, but it is probably related to problems with digestion and increased sensitivity of the gut.
  • The placebo effect (Catassi et al, 2013: 3849). This means that when someone strongly believes that they have NCGS even when they don’t, when they start to eat a gluten-free diet they feel better.
  • We do not know whether or not NCGS is always a long-term condition. In some people it may be very short-term, transient or passing.

What are the symptoms of NCGS?

NCGS can cause a number of different symptoms. Gastrointestinal symptoms include bloating, abdominal pain, diarrhoea or constipation (Catassi et al, 2013: 3843). Extra-intestinal symptoms, i.e. symptoms that are not gastrointestinal, include headaches, dermatitis, skin rashes, joint pain, ‘brain-fog’, tiredness and fatigue. NCGS in children is less likely to cause extra-intestinal symptoms than in adults. Overall, the most common extra-intestinal symptom is tiredness, and there are no known major complications of untreated NCGS.

Please note that the symptoms of NCGS are also common symptoms of many other health conditions, and as a result, people sometimes think that they have NCGS when in fact they have another condition, or a minor and passing health problem.

What is the difference between Sweet’s syndrome and NCGS?

Sweet’s syndrome is caused by errors in the innate immune system, resulting in the activation of inflammatory cells, often for unknown reasons (see Question 1). Unlike NCGS, it is not linked to gluten, and symptoms do not stop when gluten is removed from the diet.

Is there a difference between coeliac disease and NCGS?

Yes, and some of the differences between coeliac disease and NCGS include:

  • Coeliac disease is strongly linked to gene mutation which increases your risk of developing the condition. NCGS is not.
  • No production of antibodies in response to tTG, EMA, and modified (deamidated) gliadin in NCGS, but does occur in coeliac disease (see Question 2 & 3) (Catassi et al, 2013:3847).
  • Immunoglobulin G (IgG) antibodies are produced in response to gliadin in 56.4% of NCGS patients, and 81.2% of coeliac disease patients. IgG antibodies are different from IgE antibodies, and are produced in response to pathogens, not antigens. A pathogen is a foreign invader such as a bacteria or virus or other micro-organism that can do harm, while an antigen is a molecule or protein attached to the foreign invader that activates an antibody response.
  • Only 7.7% of NCGS patients produce immunoglobulin A (IgA) antibodies in response to gliadin compared to the majority of those with coeliac disease. IgA antibodies are different from IgE and IgG antibodies, and prevent invading pathogens from attaching to any outer surface that needs to be protected, e.g. the outer surface of an internal organ, or eyes. They are mainly found in the mucous membranes, e.g. nose, breathing passages and digestive tract, but also in other substances such as tears, saliva, and blood. However, a small number of people do not make them.
  •  Unlike in coeliac disease, NCGS does not cause significant or severe inflammation, or damage to the lining of the small intestine.

Is there a difference between wheat allergy and NCGS?

Yes. There is a difference between wheat allergy and NCGS. Unlike in IgE-mediated wheat allergy, there is no production of allergen-specific IgE antibodies in NCGS (Catassi et al, 2013:3847). However, it can be difficult to distinguish between NCGS and  non-IgE-mediated wheat allergy (Catassi et al, 2013: 3842).


I (Michelle Holder) am not a registered dietician. This information has simply been provided to help you make an informed decision about your dietary choices. Please seek further advice about the suitability of a wheat-free or gluten-free diet from a registered dietician or doctor, but not a nutritional therapist.


References.

Catassi, C., Bai, J., Bonaz, B., Bouma, G., Calabrò, A., Carroccio, A., Castillejo, G., Ciacci, C., Cristofori, F., Dolinsek, J., Francavilla, R., Elli, L., Green, P., Holtmeier, W., Koehler, P., Koletzko, S., Meinhold, C., Sanders, D., Schumann, M., Schuppan, D., Ullrich, R., Vécsei, A., Volta, U., Zevallos, V., Sapone, A. and Fasano, A. (2013) Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders. Nutrients, Sept; 5(10):3839-3853 (online).

Eubank, K. , Nash, J. and Duvic, M. (2009) Sweet syndrome associated with celiac disease. American Journal of Clinical Dermatology (PubMed).

NHS Choices (2016) Food Intolerance (online). Last reviewed 11/08/16.

Further information.

NHS Choices (2016) Coeliac Disease (online). Last reviewed 4/12/16.

NHS Choices (2015) ‘Leaky Gut Syndrome’ (online).  Last reviewed 26/02/15. This is a condition that can supposedly be caused by gluten and other things, and lead to the development of certain health problems. It is a condition that is not recognised by the medical community, and there is absolutely no evidence to prove that it exists. PLEASE DO NOT BELIEVE ANYONE WHO TELLS YOU THAT SWEET’S SYNDROME IS CAUSED BY ‘LEAKY GUT SYNDROME’.

NHS Choices (2015) Should you cut out bread to stop bloating? (online). Last reviewed 18/05/16. Includes information on bread-related gut symptoms, health problems caused by wheat, and the anti-bloat FODMAP diet (originally designed for people with IBS).

Tousseau, J. and Durrant, K. (2014) Myth 6: It must be an allergy. Stop eating diary, wheat, gluten, MSG, etc and you will be fine in “It’s Just a Fever,” and Other Myths & Misconceptions About Periodic Fever Syndromes. SAID Support, May 22nd (online).

© 2012-2017 Sweet’s Syndrome UK

Sweet’s syndrome and an increased risk of developing thrush

Links checked 3/04/17.

What is thrush?

Thrush is a very common fungal (yeast) infection that is caused by Candida albicans.

How is it caused?

Candida organisms live harmlessly in your gut, and in one in five women reside in the vagina. They usually coexist with other normal organisms in the body, and are kept in check by the immune system and good bacteria. However, if the immune system becomes weakened, the natural balance of the body is upset, or good bacteria are destroyed, Candida infection can develop. This can affect both the mucosa, e.g. the lining of the mouth, anus and genitals, and the skin. Less commonly, it can cause a deep-seated or persistent infection.

Are people with Sweet’s syndrome at increased risk of developing thrush?

Possibly.

A 1992 case-study showed that Sweet’s syndrome can affect the immune system’s ability to deal with fungal infection (Driesch et al, 1992). The study involved 7 patients with active Sweet’s syndrome, and in 5 out of 7 of these patients the white blood cells (immune cells that help the body fight infection) had a diminished ability to kill C. albicans fungal spores.

References.

Driesch, P., Simon, M., Gomez, R. and Hornstein, O. (1992) Impairment of some granulocyte functions in Sweet’s syndrome. Acta Dermato- Venereologica;72(2):109-11 (PubMed).

Further information.

Oakley, A. (2003) Candida. DermNet NZ (online). Accessed 3/04/17.

© 2012-2017 Sweet’s Syndrome UK

Smoking and Sweet’s Syndrome

Updated 3/04/17.

Should you stop smoking if you have Sweet’s syndrome?

Ideally, yes.

If you are diagnosed with Sweet’s syndrome, it is very important to try to stop smoking for the following reasons:

  • Smoking is bad for overall health.
  • Smoking is bad for the skin.
  • Some people with Sweet’s syndrome are taking medication or develop their Sweet’s syndrome secondary to a condition that weakens or severely weakens their immune system. This means that they are more likely to develop infections, and infection can sometimes trigger Sweet’s syndrome. This is because some people with Sweet’s syndrome experience hypersensitivity reaction (not the same as allergic reaction). Read more here.
  • Smoking increases your risk of developing a respiratory infection, and upper respiratory tract infection is the commonest infectious trigger for Sweet’s syndrome.

What are upper respiratory tract infections?

Upper respiratory tract infections are illnesses caused by an acute infection which involves the upper respiratory tract: nose, sinuses, pharynx, larynx, and bronchi (airways going into the lungs). They commonly include tonsillitis, pharyngitis, laryngitis, sinusitis, bronchitis, otitis media (middle-ear infection), flu, and the common cold.

What are the symptoms of an upper respiratory tract infection?

A cough is the most common symptom of an upper respiratory tract infection. Other symptoms include:

  • Fever.
  • Headaches.
  • Stuffed or runny nose.
  • Sneezing.
  • Sore throat.
  • Muscle aches and pain

The symptoms of an upper respiratory tract infection usually pass within one to two weeks.

Smoking is bad for the skin. Why is this?

Smoking is bad for the skin because it can (Simpkin and Oakley, 2016):

  • Speed-up the skin ageing process. Ageing of the skin means that it can sag; develop wrinkles and lines; becomes dry and coarse; have uneven skin colouring; blood vessels can be more prominent.
  • Slow-down wound healing which means that skin injuries and surgical wounds will take longer to heal.
  • Increase your risk of skin or wound infection.
  • Double your risk of skin cancer (squamous cell carcinoma), and increase your risk of developing other cancers. 75% of cases of oral cancer and lip cancer occur in smokers.
  • Increase your risk of developing the disabling skin condition palmoplantar pustulosis which mainly affects middle-aged women, particularly those who smoke (more than 90% of cases).
  • Increase your risk of developing other skin conditions, e.g. psoriasis, hidradenitis suppurativa and cutaneous lupus erythematosus.
  • Make skin conditions worse and more difficult to treat.
  • Make certain medications less effective, e.g. insulin, analgesics, antipsychotics, and anticoagulants.

References.

Simpkin, S. and Oakley, A. (2016) Smoking and its effects on the skin. DermNet NZ (online). Originally published in 2010, and updated by Professor A. Oakley in Nov 2016. Accessed on 3/04/17.

Further information.

NHS Choices (2016) Live Well – Stop Smoking (online). Accessed 3/04/17.

© 2012-2017 Sweet’s Syndrome UK

Sweet’s Syndrome, Photosensitivity & Photoexacerbated Dermatoses.

Updated 6/02/17.

What is photosensitivity?

Photosensitivity is a sensitivity to sunlight or ultraviolet (UV) light, and can sometimes increase your risk of sunburn, depending upon the cause. In some people, photosensitivity can cause a skin rash or other type of skin lesion, and skin lesions triggered by sunlight or UV light are called photodermatoses.

What are photoexacerbated dermatoses?

Photoexacerbated dermatoses are a form of photodermatoses caused by a pre-existing condition or skin disease. They can get worse on exposure to sunlight or UV light. Photoexacerbated dermatoses include:

  • Lupus erythematosus (Oakley, 2016).
  • Dermatomyositis.
  • Darier disease.
  • Rosacea.
  • Pemphigus vulgaris.
  • Pemphigus foliaceus.
  • Atopic dermatitis.
  • Psoriasis (Ibid).

Is Sweet’s syndrome a type of photoexacerbated dermatosis?

Possibly.

In 2011, Sweet’s syndrome was experimentally induced in a 78-year-old man by exposing him to UV light, and in 2014, Sweet’s syndrome lesions developed on the arms and back of a 40-year-old woman who had been working in the sun (Meyer et al, 2011; Verma et al, 2014).

Why does this happen?

As yet, it is not fully understood why sunlight or UV light can sometimes trigger Sweet’s syndrome, and a lot more research is required. However, there are two theories as to why this might happen.

THEORY NO. 1.

Koebner phenomenon or isomorphic response (Meyer et al, 2011; Verma et al, 2014).

What does this mean?

This means that in areas where the skin is damaged or irritated by overexposure to sunlight or UV light, skin lesions could develop.

Please note that patients with Sweet’s syndrome can also demonstrate a very similar kind of response to Koebner phenomenon or isomorphic response. This is referred to as pathergy. Read more here.

THEORY NO. 2.

Overexposure to UV-B light (shortwave light that causes skin reddening and sunburn) leading to the activation of white blood cells called neutrophils as a result of cytokine production (Meyer et al, 2011; Verma et al, 2014).

What does this mean?

This means that when the cells of the skin are damaged by sun, cells next to the damaged cells start spreading cytokines. These are proteins and molecular messengers that are stored by the cells of the immune system. When these cytokines are released, this causes inflammation as the first response of the immune system to destroy the damaged cells after which the damaged skin starts to heal. Certain cytokines have been proven to play a role in Sweet’s syndrome, including endogenous granulocyte colony-stimulating factor (G-CSF), which can promote the production of neutrophils. Patients with active Sweet’s syndrome usually have an increased number of neutrophils in their blood, and neutrophils also infiltrate their tissues, particularly the skin. Read more here.

Important information!

Dapsone and tetracycline antibiotics, e.g. minocycline and doxycycline, are treatments for Sweet’s syndrome. They are known to cause photosensitivity, and this can increase the risk of sunburn.

References.

Oakley, A. (2016) Photosensitivity. DermNet NZ (online). Originally published in 1997. Updated by Professor Oakley, Jan 2016.

Meyer, V., Schneider, S., Bonsmann, G. and Beissert, S (2011) Experimentally Confirmed Induction of Sweet’s Syndrome by Phototesting.  ACTADERMATO-VENEREOLOGICA (online).

Verma, R., Vasudevan, B. and Mitra, D. (2014) Unusual presentation of idiopathic sweet’s syndrome in a photodistributed pattern. Indian Journal of Dermatology; 59(2): 186-189 (online).

Other information.

Ngan, V. (2006) Drug-induced photosensitivity. DermNet NZ (online). Accessed 06/02/17.

© 2012-2017 Sweet’s Syndrome UK