PONE-D-23-03782Celiac Disease and COVID-19 in Adults: A Systematic ReviewPLOS ONE

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Additional Editor Comments:

This manuscript assesses a systematic review on COVID-19 in adults with celiac disease. The topic studied is relevant for clinical practice in gastroenterology, general medicine and in the discovery of predisposing factors to the virus. I recommend the major revision of the manuscript, due mainly to the temporary uncluttered study design as well as the certain poor, imprecise sentences provided in the manuscript. The main arguments are listed below:

1. Since the review is based on the COVID 19 pandemic that appeared in December 2019, the authors should study articles after December 2019, not before December 2019. Therefore, many of the studies referred to prior to this date should be eliminated:

2. The authors assert that the risk of acquiring COVID-19 in CD patients is lower than in the general population but do not explain in detail. Moreover, in patients in whom you found a risk, they also do not detail exactly why.

3.What's new in your article? The importance of this article in relation to existing articles should be emphasized, describing what is new about it.

4. Important findings should be reflected in the abstract "females were more likely to be infected by COVID-19, and the most common comorbidity in infected patients was a chronic lower respiratory disease; around 10% of infected patients needed hospitalization, GFD adherence, and HR-QOL was more or less the same before and during the pandemic, depression, anxiety, and stress levels of patients varied among studies. Patients had more difficulties accessing GFPs based on limited data.”

5. There are incoherent sentences in the current situation, so it is recommended to eliminate them and try to show own conclusions: "Further studies with larger populations are needed" or "Further studies with more robust designs are needed to draw definite conclusions".

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: 1.The COVID 19 pandemic appeared in December 2019. If you want to study the articles on this topic, you study articles after December 2019, not before December 2019:

1.Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Green PH, Kelly CP, Ahuja V,

Makharia GK. Global prevalence of celiac disease: systematic review and meta-analysis.

Clinical gastroenterology and hepatology. 2018 Jun 1;16(6):823-36.

2. Bascuñán KA, Vespa MC, Araya M. Celiac disease: understanding the gluten-free diet.

European Journal of Nutrition. 2017 Mar;56(2):449-59.

5. Shan L, Molberg Ø, Parrot I, Hausch F, Filiz F, Gray GM, Sollid LM, Khosla C. Structural

basis for gluten intolerance in celiac sprue. Science. 2002 Sep 27;297(5590):2275-9. doi:

10.1126/science.1074129. PMID: 12351792.

6. Rodrigo L. Celiac disease. World J Gastroenterol. 2006 Nov 7;12(41):6577–84. doi:

10.3748/wjg.v12.i41.6585. Epub 2006 Nov 7. PMCID: PMC4125661.

7. Bouziat R, Hinterleitner R, Brown JJ, Stencel-Baerenwald JE, Ikizler M, Mayassi T,

Meisel M, Kim SM, Discepolo V, Pruijssers AJ, Ernest JD, Iskarpatyoti JA, Costes LM,

Lawrence I, Palanski BA, Varma M, Zurenski MA, Khomandiak S, McAllister N,

Aravamudhan P, Boehme KW, Hu F, Samsom JN, Reinecker HC, Kupfer SS, Guandalini S,

Semrad CE, Abadie V, Khosla C, Barreiro LB, Xavier RJ, Ng A, Dermody TS, Jabri B.

Reovirus infection triggers inflammatory responses to dietary antigens and development of

celiac disease. Science. 2017 Apr 7;356(6333):44-50. doi: 10.1126/science.aah5298. PMID:

28386004; PMCID: PMC5506690

9. Mårild K, Fredlund H, Ludvigsson JF. Increased risk of hospital admission for influenza in

patients with celiac disease: a nationwide cohort study in Sweden. Am J Gastroenterol. 2010

Nov;105(11):2465-73. doi: 10.1038/ajg.2010.352. Epub 2010 Sep 7. PMID: 20823839.

10. Dieterich W, Esslinger B, Schuppan D. Pathomechanisms in celiac disease. International

archives of allergy and immunology. 2003;132(2):98-108.

31. S. Schmidt, H. Mühlan, M. Power, The EUROHIS-QOL 8-item index: psychometric

results of a cross-cultural field study, Eur. J. Pub. Health 16 (4) (2005) 420–428.

33. S.H. Lovibond, P.F. Lovibond, Manual for the Depression Anxiety Stress Scales, 2nd.

Ed., Psychology Foundation, Sydney, 1995. ISBN: 7334-1423-0.

34. Vader W, Stepniak D, Kooy Y, Mearin L, Thompson A, van Rood JJ, Spaenij L, Koning

F. The HLA-DQ2 gene dose effect in celiac disease is directly related to the magnitude and

breadth of gluten-specific T cell responses. Proceedings of the National Academy of

Sciences. 2003 Oct 14;100(21):12390-5.

35. Dendrou CA, Petersen J, Rossjohn J, Fugger L. HLA variation and disease. Nature

Reviews Immunology. 2018 May;18(5):325-39.

36. Lin M, Tseng HK, Trejaut JA, Lee HL, Loo JH, Chu CC, Chen PJ, Su YW, Lim KH, Tsai

ZU, Lin RY. Association of HLA class I with severe acute respiratory syndrome coronavirus

infection. BMC medical genetics. 2003 Dec;4(1):1-7.

THE ARTICLES ABOVE DO NOT CORRESPOND WITH THE TITLE OF THE ARTICLE

2."The risk of acquiring COVID-19 in CD patients is lower than in the general population"

The risk is low! ok, but develop a bit. For the patients in whom you found a risk, detail it! What is it about? Why did they contact the virus?

3.What's new in your article?

4.PUT THESE CONCLUSIONS IN ABSTRACT: "females were more likely to be infected by COVID-19, and the

most common comorbidity in infected patients was a chronic lower respiratory disease;

around 10% of infected patients needed hospitalization, GFD adherence, and HR-QOL was

more or less the same before and during the pandemic, depression, anxiety, and stress levels

of patients varied among studies. Patients had more difficulties accessing GFPs based on

limited data

5.DELETE THIS:

DELETE: "Further studies with larger populations are needed." BECAUSE The COVID19 pandemic is no more. If you ask for this, does it mean you want another COVID19 pandemic to come?

DELETE: "Further studies with more robust designs are needed to draw definite conclusions" - From what you have, show some conclusions!

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Reviewer #1: Yes: SAMASCA GABRIEL

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Celiac disease and COVID-19 in adults: A systematic review

PONE-D-23-03782R1

Dear Dr. Zarpoosh,

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Kind regards,

María de Lourdes Moreno Amador, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: