6 months in, still having symptoms...my GI sent me to Dermatologist and Allergist looking for answers.

[cnazrael89]

Hello, I have continued to be vigilant in my gluten free diet; sticking with mostly whole foods with the exception of peanut butter, oikos yogurt, larabar's and the very seldom certified gluten free chip/cracker when I just want to have something that makes me feel "normal".

I was doing quite well up until the end of February, when I started to have fatigue, brain fog, Diarrhea, severe daily continuous headaches, congestion mostly at night, sneezing often mostly at night, itchy top of mouth and rash that started on both hands. Later, the rash started to appear on my neck and left side rib area. I saw my GI and got some labs drawn. Celiac antibodies all trending down appropriately for the amount of time I have been gluten free. CBC and CMP looked fine. I figured I had been glutened and that the symptoms would go away. The symptoms persisted and I kept looking into my diet to eliminate any possible gluten exposure. I decided to get rid of a seasoning I had purchased that was labeled "gluten free" and my headaches went away but the other symptoms persisted. Symptoms continued with the addition of Nausea that began after I would eat and would persist for about 1 to 2 hours after. I wouldn't ever vomit but just felt "ill" whenever I would. The rash on my hands, neck and left ribs continued to be flared up. I again reached out to my GI doctor due to the continued symptoms and new symptoms. They ordered repeat CBC and CMP, CRP, Stool culture, Calprotectin (stool), and Stool GI panel. all of the stool studies came back negative for infection/parasites/inflammation. However, on my CBC, now I had significant Eosinophilia that was not present just over a month before. My eosinophils rose from 4% up to 28% and my GI referred me to an Allergist/dermatologist for further testing.

I had a scoop biopsy from directly on some of the bumps/pustules on one of my fingers and then they took a punch biopsy from unaffected skin on my forearm (not near any lesions). I'm still waiting to hear back on the biopsy results for these. However, I was put on a 1 week medrol dose pack by my GI to help calm my system down and while I was on the steroid the rash slightly improved but the day after I completed the steroids, the rash flared right back up and actually was worse than before. Now, the rash continues to worsen and involves the entire tops of both hands and on all of my fingers. the neck rash and torso rash went away with steroids and haven't come back since. I have been using triamcinolone cream on my hands and it doesn't seem to be helping. The rash is extremely itchy, with burning and I am developing large cracks on my fingers with thickening skin. The cracking is painful. 

I saw the allergist and had scratch testing done. I reacted to pretty much every environmental allergen tested and reacted to many foods that they tested for. I reacted on the skin test to peanuts, watermelon, cucumber, walnuts, pecans, pistachios, hazelnuts, dairy, and almonds. The allergist then sent me for blood work testing for total IgE and specific food IgE to what I reacted to on skin test. I came back with Class 4 "very high" specific IgE levels for pistachio, almond, dairy, walnuts, peanuts, hazelnuts, and pecans. My total IgE came back 8,800 kU/L (standard range less than 214 kU/L). I'm still waiting to hear back from allergist regarding these results. It appears that my body is mounting a huge immune response and maybe a lot of the on-going symptoms I am having are related to possibly new food allergies. Does this sound like a gut permeability issue leading to new allergies, related to my Celiac disease? Also, important to note, the allergist specifically ordered a serum histamine level to assess for mast cell activation syndrome and my histamine was high normal at 8 (standard range 0-8). She also checked a rheumatoid factor and ANA which both came back normal. My allergist said she thinks I am just extremely Atopic and she wants to wait until the biopsy results come back for the rash to make any further plans. She mentioned wanting to put me on a biologic (dupixent) depending on whether the rash is atopic dermatitis....I have no idea about any of that though... She also wants to discuss putting me on allergy shots tailored to my specific allergens.

Allergist mentioned wanting to check for EoE as well at some point because I have been having issues with food getting caught in the back of my throat and having trouble getting it to clear when it happens.. I have an EGD tentatively scheduled for October as my GI wanted to go in and look after 1 year gluten free. She actually mentioned she may want to do the EGD sooner if my symptoms persist and at that point EoE could be assessed.

I was going to be checked for SIBO on May 7th but a part on the machine broke and they had to cancel it until it can be fixed.

Does Leaky gut related to Celiac disease cause full blown IgE mediated allergies to develop or is it generally more of just food intolerances that develop from leaky gut?

It appears my re-occurring/on-going symptoms may be indirectly related to my Celiac disease, by way of new food allergies but not specifically by getting glutened like I originally thought I was. Anyone experience something similar? It feels like I'm on the right track to getting things figured out. Any thoughts or suggestions would be appreciated! 

 

[Scott Adams]

To me the images look nearly identical to dermatitis herpetiformis, which is the skin condition associated with celiac disease. I had this on my right hand for years, and even tiny amounts of gluten can trigger it for weeks. If it is DH, iodine in dairy, seafood, salt and other foods like seaweed can also trigger outbreaks in some people.

Just in case:

 

PS - Due to the leaky gut condition that many celiacs have upon diagnosis, additional food and other allergies can develop and existing ones magnified, and after your gut heals this may change over time, and those additional food intolerances and/or allergies may fade away.

[Wheatwacked]

     My first thought is vitamin D for the overall immune system failure.  From your description you might be in negative numbers, if that were possible.😀

I have to take 10,00 IU a day to keep my blood level at 80 ng/ml.  Started in 2015   and it took from  Every time I stop, I start noticing issues (I stop answering the phone for one) in about two weeks.  It  and TPH get tested twice a year.

    Vitamin D and inflammatory diseases   "Beyond its critical function in calcium homeostasis, vitamin D has recently been found to play an important role in the modulation of the immune/inflammation system via regulating the production of inflammatory cytokines and inhibiting the proliferation of proinflammatory cells, both of which are crucial for the pathogenesis of inflammatory diseases." 

Itchy mouth could be an allergy symptom.  Same with hands, a contact allergy. It all comes back to multiple vitamin and mineral deficiencies. 

When you gave up fortified wheat there are nutrients that you will be deficient in. That's why they are fortified.

If not for the DH I would suggest trying a bottle of Geritol Multivitamin or similar, not sure if the iodine would exaceperate you rash. Take extra vitamin D and Phosphatidyl choline The Geritol Multi has 100% Daily Value of most essential vitamins. Keep in mind that 100% is only the minimum intake. It's a shotgun approach but saves time and most of the tests available for vitamins and minerals don't reflect intracellular values anyway; that's where they are important. The vitamin D test is accurate.

Fatigue, brain fog diarrhea and Nausea could all be low choline. In many it is misdiagnosed as gall bladder and the offending organ is removed. Choline, B6, B12 and folate help lower homocystein level, an indicator of cardiovascular inflammation.

Gall Bladder, A Vital Organ That is Being Removed At Alarming Rates

A good overview of the effects of vitamin and mineral deficiencies.

 

[Russ H]

There is an association between coeliac disease and IgE mediated food allergy.

https://journals.lww.com/jpgn/Abstract/2023/01000/Celiac_Disease_Frequency_Is_Increased_in.9.aspx

It does not seem well understood currently. Have you looked at things like shower gel, shampoo and clothes washing detergent? I have become quite allergic to certain brands and come up in a rash if I use them.

[cnazrael89]

11 hours ago, Scott Adams said:

To me the images look nearly identical to dermatitis herpetiformis, which is the skin condition associated with celiac disease. I had this on my right hand for years, and even tiny amounts of gluten can trigger it for weeks. If it is DH, iodine in dairy, seafood, salt and other foods like seaweed can also trigger outbreaks in some people.

PS - Due to the leaky gut condition that many celiacs have upon diagnosis, additional food and other allergies can develop and existing ones magnified, and after your gut heals this may change over time, and those additional food intolerances and/or allergies may fade away.

Thanks for your input @Scott Adams. Unfortunately, The dermatologist did some weird biopsies and if it is DH, they didn't see it with the punch biopsy they did. For one, I have been gluten free for 6 months so I don't know if they can get an accurate biopsy on it anyway. Secondly, they took the biopsy in a random clear spot on my forearm not even anywhere near my rash. In fact, the punch biopsy gave them exactly zero information. The other biopsy they did was a scrape from the actual rash/bumps on my finger. They couldn't give me a clear cut diagnosis of the rash from that biopsy either...they mentioned psoriasis, dyshidrotic eczema, and atopic dermatitis...I'm waiting for the actual report on the scrape biopsy to see their wording. They did prescribe 10 days more of prednisone 20mg and prescribed a stronger topical corticosteroid cream. We'll see what happens. Thanks.

[cnazrael89]

10 hours ago, Wheatwacked said:

My first thought is vitamin D for the overall immune system failure.  From your description you might be in negative numbers, if that were possible.😀

I have been taking 10,000 IU of Vitamin D3 since diagnosis 6 months ago. Initially I was mid 20's when checked and last time I checked it in late February it was 68. I have maintained taking the 10,000 IU of vitamin D3 since that time as well.

 

10 hours ago, Wheatwacked said:

Fatigue, brain fog diarrhea and Nausea could all be low choline. In many it is misdiagnosed as gall bladder and the offending organ is removed. Choline, B6, B12 and folate help lower homocystein level, an indicator of cardiovascular inflammation.

I have been heavily supplementing since diagnosis. I take a B Complex morning and night, Benfotiamine 300mg three times a day, Copper 2.5mg daily (I was deficient at diagnosis and remained deficient as of February), Calcium approximately 350mg daily to make up for any dietary shortcomings (I have Osteoporosis at time of Celiac diagnosis), I take a vitamin K2 MK-7/MK-4 combo supplement daily, and Magnesium Glycinate 400mg nightly...

I think I am just getting impatient with the process because lately I have been feeling sicker than before I went gluten free. However, I think I am on the right track by eliminating the newly discovered food allergies and awaiting my SIBO breath test when the machine is repaired at GI office. Also, my homocysteine level was within the standard range when checked at time of diagnosis.

I think I am doing "all the right things" and just need to keep waiting out the healing time as I had near complete villous atrophy on my pathology report at time of diagnosis in October.

I do appreciate being able to get on here and type everything out as a narrative to help me make sense of things and get helpful input from people like yourself. I'm ready for the days where I can feel like Celiac isn't ruling my life and I can get to a new norm, where Celiac disease isn't the 100% focus in my life. I understand I always must be vigilant and smart about it, but ready to be able to take a deep breath of fresh air on the other side of healed intestines.

Thanks for taking the time.

[cnazrael89]

6 hours ago, Russ H said:

There is an association between coeliac disease and IgE mediated food allergy.

https://journals.lww.com/jpgn/Abstract/2023/01000/Celiac_Disease_Frequency_Is_Increased_in.9.aspx

It does not seem well understood currently. Have you looked at things like shower gel, shampoo and clothes washing detergent? I have become quite allergic to certain brands and come up in a rash if I use them.

Interesting little read. Thank you for that. I have looked into the body wash, shampoo and detergent but I may try changing what I use to something else that is safe and maybe tailored more for the sensitive skin now that I am having rash issues. I don't think that could hurt anything. Thanks for the tip!

[Guest 648]

cnazrael89, regarding your rash.  If you still suspect DH you might want to ask your dermatologist about trying dapsone pills for it.  It supposedly can wipe out a DH rash in a really short amount of time/days.  It also helps with the itching.  It can be used as a diagnostic tool for DH.  I was offered it by my dermatologist but I could not take it due to a possible drug interaction with other meds I take.  You might also ask about a more powerful steroid cream like Clobetasol. 

 

Were you able to read the actual biopsy reports?  You can learn a lot from them.

Good luck and post back about what you learn about your rashes. 

.....648

 

Good luck and I am rashed up all the time and its bad party.

[Scott Adams]

14 hours ago, cnazrael89 said:

Thanks for your input @Scott Adams. Unfortunately, The dermatologist did some weird biopsies and if it is DH, they didn't see it with the punch biopsy they did. For one, I have been gluten free for 6 months so I don't know if they can get an accurate biopsy on it anyway. Secondly, they took the biopsy in a random clear spot on my forearm not even anywhere near my rash. In fact, the punch biopsy gave them exactly zero information. The other biopsy they did was a scrape from the actual rash/bumps on my finger. They couldn't give me a clear cut diagnosis of the rash from that biopsy either...they mentioned psoriasis, dyshidrotic eczema, and atopic dermatitis...I'm waiting for the actual report on the scrape biopsy to see their wording. They did prescribe 10 days more of prednisone 20mg and prescribed a stronger topical corticosteroid cream. We'll see what happens. Thanks.

You can look this up, but the biopsy for DH needs to be done directly next to a blister. If they took a sample on a clear patch of skin that was totally unaffected by the rash, I believe they were not following the protocol for a DH biopsy.

[cnazrael89]

50 minutes ago, 648 said:

You might also ask about a more powerful steroid cream like Clobetasol. 

 

Were you able to read the actual biopsy reports?  You can learn a lot from them.

CLINICAL DIAGNOSIS: Dermatitis unspecified.

GROSS DESCRIPTION: This is a shave biopsy.

MICROSCOPIC DESCRIPTION: The specimen is a shave biopsy of skin present as multiple H&E stained sections on one slide.  The pathologic process is that of compact hyperkeratosis with areas of scale crust overlying a regular psoriasiform hyperplasia of the epidermis. There is spongiosis and a superficial perivascular distribution consisting mostly of lymphocytes. 

PATHOLOGICAL DIAGNOSIS: Regular psoriasiform dermatitis with spongiosis, see comment. 

COMMENT: This may be associated with psoriasis or lichen simplex chronicus and clinical correlation is recommended.

This is the report I just received this morning from Derm. The punch biopsy path report simply says "negative" next to everything they look for.

Fortunately they did put me on 10 days prednisone 20mg to calm this down and prescribed the Clobetasol cream since Triamcinolone wasn't doing anything at all and the rash was still spreading and popping up other locations.

The Derm I saw wasn't Interested in anything DH related. 

Thanks so much for your insight on this and personal experiences.
 

[cnazrael89]

1 minute ago, Scott Adams said:

You can look this up, but the biopsy for DH needs to be done directly next to a blister. If they took a sample on a clear patch of skin that was totally unaffected by the rash, I believe they were not following the protocol for a DH biopsy.

I 100% agree with you on this and told the dermatologist this and they had total disregard for the information I provided about proper DH biopsy location. I should have just declined but to be honest I was desperate and also so hopeful maybe by chance it would show something instead of trying to arrange another dermatologist appointment as I had active new lesions and didn't know if I would have untouched lesions by the time I could get a different appointment....oh well I guess...just unfortunate, you can bring proper standards in for them and they don't listen to the person that has the problem.. thank you for the info as it confirmed my suspicions on the matter.

[Scott Adams]

It never ceases to amaze me why some in the medical profession can still be so ignorant, or worse yet, insolent (hard to say which here, but if you came into the office wanting to be tested for DH, and they then ignored you and tested you for something else, it could be the latter). 

Again, I'm obviously no dermatologist or doctor, but my DH spot looked exactly like yours, but I only had it on the back of my hand in a 1.5x1.5 inch area on the lower knuckle of my right thumb. Ironically I got a severe sunburn on the back or my hands while fishing at a 7,500+ft. mountain lake, sunburn to the point where the back of each hand became one giant blister, and the DH never came back. There is some research that indicates that UV treatments help it, at least I was told that back in the late 90's, but I definitely don't recommend such a sunburn to anyone. It would be interesting if lesser levels of UV could help it.

[Russ H]

That is interesting. UV is also used to treat psoriasis that won't respond to other treatments.

[cnazrael89]

47 minutes ago, Scott Adams said:

There is some research that indicates that UV treatments help it, at least I was told that back in the late 90's, but I definitely don't recommend such a sunburn to anyone. It would be interesting if lesser levels of UV could help it.

Interesting, I have been out in the sun some and I actually felt like the itching and burning eased up after a few days of light outside time. But the relief was temporary and didn't last.

[Blue-Sky]

On 5/3/2023 at 2:45 AM, cnazrael89 said:

Does Leaky gut related to Celiac disease cause full blown IgE mediated allergies to develop or is it generally more of just food intolerances that develop from leaky gut?

If someone is Celiac allergies (IGE) are more common. There is also though some bacteria disturbances which frequent in Celaic disease. Certain T-reg cells can remember different antigens and move to different parts of the body.

Exposure to an antigen in the digestive track can promote tolerance to that antigen.  There is likely an over exposure to certain bacteria which put the immune system on high alert and a lack of exposure to other types of bacteria that are known to desensitize the immune system. This will affect the types of t-reg cells that are created how they get sensitized. Getting the right kind of fiber (without added sugar) could be helpful.

Also zinc deficiency is common is Celiac disease before diagnosis, which could cause problems with the body.  Zinc deficiency promotes th2 immune cells, histamine intolerance and allergies.

So yes both are common.

[Wheatwacked]

15 hours ago, cnazrael89 said:

The Derm I saw wasn't Interested in anything DH related.

  Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment*   Dermatitis Herpetiformis (DH), also known as Duhring-Brocq dermatitis, is a chronic, recurrent disease, secondary to gluten hypersensitivity which main clinical manifestation is the occurrence of a papulovesicular pruriginous rash. Celiac Disease (celiac disease) is the gastrointestinal manifestation of the same etiology and it is characterized by atrophy of the intestinal mucosa...         Because of the possibility of numerous differential diagnoses, it is always desirable to perform direct immunofluorescence. For this purpose, a biopsy should be obtained from perilesional, apparently unaffected skin (up to 1 cm away .... The occurrence of IgA deposits along the dermal-epidermal junction and on top of the dermal papillae are the fundamental characteristics of DH.

On 5/4/2023 at 2:27 AM, cnazrael89 said:

I take a B Complex morning and night, Benfotiamine 300mg three times a day, Copper 2.5mg daily (I was deficient at diagnosis and remained deficient as of February), Calcium approximately 350mg daily to make up for any dietary shortcomings (I have Osteoporosis at time of Celiac diagnosis), I take a vitamin K2 MK-7/MK-4 combo supplement daily, and Magnesium Glycinate 400mg nightly...

Keep up the good work with vitamin D. The homeostasis level is around 80 ng/ml.

The minimum Choline needed daily is the equivelant of 3 eggs, or 12 ounce steak or 10 cups of brocolli.  If you are following current recommendations for "healthy diet" I doubt you are getting enough.  From NHANES data the the healthiest is the higher intakes.

Quote

Choline is an essential nutrient important for normal function of all cells and for brain development and function (1, 2). Choline availability during pregnancy is important for optimal fetal development (3).  https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/dbrief/9_choline_intakes_0708.pdf

 

Quote

Choline is an essential nutrient with critical roles in several biological processes including neuronal development, cell signaling, nerve impulse transmission, and lipid transport and metabolism. The National Cancer Institute method was used to assess usual intakes of choline from foods according to data for participants enrolled in the National Health and Nutrition Examination Survey 2009–2014 datasets and pregnant women in the 2005–2014 datasets. Suboptimal intakes of choline are present across many gender and life-stage subpopulations, as well as pregnant women in the U.S. Only 8.03 ± 0.56% of adults and 8.51 ± 2.89% pregnant women meet the AI for choline. https://www.mdpi.com/2072-6643/9/8/839 

 

 

[Rogol72]

It's a shame the Dermatologist did not follow the correct procedure for DH biopsy. My DH initially appeared to be Eczema, but when steroid cream didn't clear it up, my Dermatologist immediately took a biopsy and DH was confirmed and subsequently celiac disease. Dapsone, which has its drawbacks will clear DH outbreaks up very quickly. With DH, you need to be militant with the diet, and too much iodine will flare DH as Scott said.

Here's a great podcast about DH by Dr. Robert Pastore, a fellow Coeliac with DH ... https://open.spotify.com/episode/4tscHgIfBwQasyeovaRAwG

 

 

 

[cnazrael89]

Wanted to provide an update. I haven't been on much lately but have had a lot going on. I got a second opinion from another Dermatologist because my bilateral hand rash continued to get worse and worse and was becoming quite problematic for me. I ended up having "tapioca-like" bumps coating the palm of both hands, had bumps in between all fingers, rash/bumps/redness all over the tops of my hands and starting up my wrists. The new Dermatologist immediately said "You have severe Atopic dermatitis/Dyshidrotic eczema". I had been on all kinds of steroid creams, systemic steroids and whatnot and that wasn't working so they recommended Dupixent for severe dyshidrotic eczema. They said this can happen when I start reacting to something and I don't know what it is and just keep either ingesting it or coming into contact with something. Either way, Dupixent literally cleared the rash by the next day and the insatiable itch was gone. Now, it has come and gone since I started the medicine 1 month ago but overall is so much better. Still haven't been able to trace back to any certain exposures causing the rash at this point. The 2nd opinion dermatologist was confident this was not DH.

The other thing that happened and might actually be the cause of the sensitivities to foods and whatnot, I was diagnosed with Hydrogen SIBO yesterday. I was supposed to have a SIBO test 2 months ago but the machine was broken. They rescheduled me finally and I got the results from my GI doc the same day. They prescribed 21 days of doxycycline, low FODMAP diet, and OTC probiotics. Hoping that treating the SIBO will help with the food sensitivities/new allergies and help with this rash.

In the research I did, it seems like saccharomyces boulardii probiotic strain is a good choice for Hydrogen SIBO and isn't effected by the antibiotics and can actually protect from antibiotic related gut issues. If anyone has any good info they would like to share regarding SIBO, probiotics, Low FODMAP I would love to hear your thoughts. 

I am hoping SIBO has been the missing puzzle piece and my ongoing symptoms/issues will begin to lessen.  I've been gluten free since October 2022 when I was diagnosed with Celiac disease.

[Scott Adams]

It is certainly possible that there is another gastro explanation for your eczema, and perhaps treating the SIBO will help it improve. Since you are already gluten-free are you also making sure that you are on a low iodine diet, just in case it is DH? Iodine in sea food, dairy, salt, etc., can cause DH flare ups.

[Rogol72]

I found some useful information from Dr DiNezza about SIBO, Probiotics and Low Fodmap diet.

[cnazrael89]

19 minutes ago, Rogol72 said:

I found some useful information from Dr DiNezza about SIBO, Probiotics and Low Fodmap diet.

Thank you, I looked her up and will read/watch through some of her stuff! 

[cnazrael89]

On 7/4/2023 at 11:06 AM, Scott Adams said:

It is certainly possible that there is another gastro explanation for your eczema, and perhaps treating the SIBO will help it improve. Since you are already gluten-free are you also making sure that you are on a low iodine diet, just in case it is DH? Iodine in sea food, dairy, salt, etc., can cause DH flare ups.

I have been dairy free mostly up until now minus a little yogurt here and there, I use pink Himalayan salt, I eat canned tuna maybe once or twice a week/shrimp 1 or 2x per week....I do eat 2 to 3 eggs per day. But overall I don't feel like I overdo those foods...thank you for the insight!

[Guest 648]

I get this same rash.  It also goes by the name pompholyx.  I only get mine during the summer months.  Sweating can bring it on(of many other reasons).  Although my hands do not sweat, but like clockwork I get in every summer.  Its only on my hands and between fingers.  I've been getting it every year for about 40 years now.  I don't really do anything for it because mine is a mild affliction, more of a nuisance than anything else.  Sometimes I will apply a bit of clobetasol but I really don't worry about it because its minuscule compared to the other rashes I battle.

 

I'm glad you are making progress.  May it continue.

[Scott Adams]

On 7/4/2023 at 3:45 AM, cnazrael89 said:

Wanted to provide an update. I haven't been on much lately but have had a lot going on. I got a second opinion from another Dermatologist because my bilateral hand rash continued to get worse and worse and was becoming quite problematic for me. I ended up having "tapioca-like" bumps coating the palm of both hands, had bumps in between all fingers, rash/bumps/redness all over the tops of my hands and starting up my wrists. The new Dermatologist immediately said "You have severe Atopic dermatitis/Dyshidrotic eczema". I had been on all kinds of steroid creams, systemic steroids and whatnot and that wasn't working so they recommended Dupixent for severe dyshidrotic eczema. They said this can happen when I start reacting to something and I don't know what it is and just keep either ingesting it or coming into contact with something. Either way, Dupixent literally cleared the rash by the next day and the insatiable itch was gone. Now, it has come and gone since I started the medicine 1 month ago but overall is so much better. Still haven't been able to trace back to any certain exposures causing the rash at this point. The 2nd opinion dermatologist was confident this was not DH.

The other thing that happened and might actually be the cause of the sensitivities to foods and whatnot, I was diagnosed with Hydrogen SIBO yesterday. I was supposed to have a SIBO test 2 months ago but the machine was broken. They rescheduled me finally and I got the results from my GI doc the same day. They prescribed 21 days of doxycycline, low FODMAP diet, and OTC probiotics. Hoping that treating the SIBO will help with the food sensitivities/new allergies and help with this rash.

In the research I did, it seems like saccharomyces boulardii probiotic strain is a good choice for Hydrogen SIBO and isn't effected by the antibiotics and can actually protect from antibiotic related gut issues. If anyone has any good info they would like to share regarding SIBO, probiotics, Low FODMAP I would love to hear your thoughts. 

I am hoping SIBO has been the missing puzzle piece and my ongoing symptoms/issues will begin to lessen.  I've been gluten free since October 2022 when I was diagnosed with Celiac disease.

This post might also be helpful:

 

[Rogol72]

FYI. Here's a case report of SIBO treatment using the functional/integrative approach with herbal antimicrobials and Low Fodmap diet. Though the patient in the report was not Coeliac but had IBS, it was treated successfully.

https://www.spandidos-publications.com/10.3892/ijfn.2021.23#