Celiac Disease Can Raise Your Risk for Pneumonia

But only in unvaccinated patients, one study shows

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If you have celiac disease, you're probably well aware that it raises your risk for other conditions, including additional autoimmune diseases, osteoporosis, and even lactose intolerance. But you might not realize that your risk of pneumonia may be higher than average, as well.

Pneumonia, a lung infection, can cause potentially serious illness in people of all ages.

But it tends to be more serious in the elderly and in those with chronic health conditions. In fact, pneumonia is the seventh-most-common cause of death in those age 65 and older in the United States.

So it's obviously potentially bad news to learn that those with celiac disease may be at higher risk for pneumonia. Fortunately, there's something simple you can do to help remedy the problem: get vaccinated.

Causes of Pneumonia

There are many different types of pneumonia. Several different infectious agents can cause the illness, including bacteria, viruses, and fungi. It's even possible to contract pneumonia as a result of being on a ventilator in a hospital or other health care facility. However, the majority of pneumonia cases are acquired outside the hospital; hence the term "community-acquired pneumonia."

The most common symptoms seen with pneumonia are a cough, shortness of breath, fever, and chills, and weakness.

You may expel yellow or green mucus when you cough, and your chest might hurt. Pneumonia can cause confusion in the elderly.

When someone says they have "walking pneumonia," it generally means they have a less severe form of the illness, potentially caused by a bacteria known as Mycoplasma pneumoniae. 

Influenza (e.g., "the flu") is a virus that can cause viral pneumonia. Research has shown that having celiac disease increases your flu-related hospitalization risk.

Pneumonia of any type can quickly turn serious, leading to hospitalization and even death. Each year in the United States, more than 1 million people are hospitalized with pneumonia, and some 50,000 people die of the disease.

If you contract pneumonia, your pneumonia treatment will depend on the type of pneumonia you have. Bacterial pneumonia, for example, can be treated with antibiotics, but pneumonia from a viral infectious agent does not respond to antibiotics, although your doctor may prescribe an antiviral drug. Regardless of what caused your pneumonia, you'll need to rest, drink plenty of fluids, and take any medication your doctor recommends to control your fever.

What We Know About Celiac Disease and Pneumonia Risk

There haven't been many studies that looked specifically at the risk of pneumonia in those with celiac disease. But those that have been conducted do show some risk.

One study, conducted in the United Kingdom, provides the most comprehensive look at the issue. The study tracked 9,803 people with celiac disease, along with 101,755 people who didn't have the condition for comparison purposes.

The study, which spanned 15 years, included all age groups.

Overall, the researchers identified 179 cases of pneumonia among those who had celiac disease, compared to 1,864 cases in those people who didn't have celiac. That works out to similar odds for those with celiac to catch pneumonia, when compared with those who didn't have the condition.

However, the researchers also identified a 28 percent increased risk of pneumonia in people younger than age 65 who had celiac disease and who had not been vaccinated for pneumonia. This increased risk was highest around the time of diagnosis—at that time, the risk was twice as high for any type of infectious pneumonia and four times as high for pneumococcal pneumonia, the researchers said.

However, the risk remained elevated for more than five years following that celiac disease diagnosis.

The study concludes: "Unvaccinated patients with coeliac disease under the age of 65 have an excess risk of community-acquired pneumonia that was not found in vaccinated patients with coeliac disease. As only a minority of patients with coeliac disease are being vaccinated, there is a missed opportunity to intervene to protect these patients from pneumonia."

Risk of Dying From Pneumonia Is Also Higher

The risk of dying from pneumonia also may be higher, at least in those whose celiac disease was particularly severe at the time of their diagnosis.

Research from Sweden looked at the causes of death in more than 10,000 people who had been hospitalized at the time of their diagnosis with celiac disease and compared those causes of death to the country's overall population. They found death risks in those with celiac disease were higher for "a wide array of diseases," including pneumonia. 

In fact, those tracked in the Swedish study were nearly three times as likely to die of pneumonia when compared to the overall population.

Keep in mind that these people had been seriously ill when diagnosed with celiac disease—most people aren't hospitalized prior to or during their celiac diagnosis. However, it does provide an additional caution signal when considering the pneumonia risk of those with celiac disease.

How to Lower Your Risk of Pneumonia

Pneumonia can be dangerous—as you read above, it's the seventh-leading cause of death for those over age 65 in the United States. Although the United Kingdom study didn't show that those older than age 65 with celiac disease face an additional risk of pneumonia if they aren't vaccinated, that doesn't mean older people are in the clear—vaccination potentially is even more important for them, because the risk of pneumonia is higher in everyone over age 65.

So if you have celiac disease, you can lower your risk of catching pneumonia by getting vaccinated for pneumonia. There are two pneumonia vaccines available (known as Prevnar 13 and Pneumovax23), and the Centers for Disease Control and Prevention (CDC) recommends everyone over age 65, plus those whose medical conditions place them at greater risk for pneumonia, receive both.

Nonetheless, not everyone gets vaccinated for pneumonia... not by a long shot. The study from the United Kingdom found that only 26.6 percent of those diagnosed with celiac disease got vaccinated for pneumonia. There's no similar study looking at vaccination rates for those with celiac disease in the United States, but data from the CDC indicates that 63 percent of all adults over age 65 have received at least one pneumonia shot. You also should get vaccinated for influenza, since the flu can lead to pneumonia.

These vaccines won't protect you against all forms of pneumonia, but they will protect you against many of the most common types. Therefore, if you have celiac disease, it just makes good sense to talk to your doctor about getting vaccinated for pneumonia—getting the recommended shots potentially could save you from an illness that can turn serious very quickly.

Finally, you should stick carefully with the gluten-free diet to potentially lower your risk of pneumonia. There's some evidence that people with celiac disease who eat gluten-free can help improve the function of their spleen, an organ that happens to play an important role in fighting pneumonia-causing bacteria.


Centers for Disease Control and Prevention. "Pneumonia Can Be Prevented: Vaccines Can Help" fact sheet.

Mårild K et al. Increased Risk of Hospital Admission for Influenza in Patients With Celiac Disease: A Nationwide Cohort Study in Sweden. American Journal of Gastroenterology.  2010 Nov;105(11):2465-73.

Peters U et al. Causes of death in patients with celiac disease in a population-based Swedish cohortArchives of Internal Medicine. 2003 Jul 14;163(13):1566-72.

Zingone F et al. The Risk of Community-Acquired Pneumonia Among 9803 Patients with Coeliac Disease Compared to the General Population: A Cohort Study. Alimentary Pharmacology and Therapeutics. 2016 May 5.