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10-14-2009, 02:10 AM | #1 | ||
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Junior Member
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My daughter was diagnosed w/ gluten sensitivity several wks ago via stool test, so I asked my dr. if I could have bloodwork to test for Celiac's.
Results: Deamidated gliadin ABS, IgA 1.7 (normal 1-10) Deamidated gliadin ABS, IgG 0.07 (normal 1-10) t-transglutaminase, IgA 1 (normal 0-3, weak positive 4-10, positive >10) t-transglutaminase, IgG 1 (normal 0-5, weak positive 6-9, positive >9) endomysial antibody, IgA negative Immunoglobulin A, QN, serum 60 L (normal for > 19 yrs is 70-400) My dr read this as meaning I'm fine, while acknowledging this isn't her area of expertise. But a naturopath dr I asked about it said that b/c my IgA is low overall, the rest of the test results are invalid, unhelpful. But he didn't have much more to say than that. Can someone point me to a good source of info to explain what all these tests are about, particularly the last one? What's next? Would IgA stool testing be similarly invalid b/c of lack of IgA? Do I need to do something about the lack of IgA? What problems could I have b/c my IgA is low? Any info helpful. Thanks. |
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10-14-2009, 09:52 AM | #2 | ||
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Member
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Quote:
that being said, if your daughter lives with you, why not go gluten free with her? |
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10-14-2009, 10:32 AM | #3 | ||
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Senior Member (jccglutenfree)
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Edit to say: What she said...lol. Here is the LONG version of the answer.
Quote:
Total IgA deficiency is of the most concern, and is defined (from what I have read) as an IgA level less than 7. If someone has total IgA deficiency they can run into problems if ever needing a blood transfusion. Below range IgA is also considered being "IgA deficient", and may make one more prone to general illness, food sensitivity, and such, but isn't considered as big of a deal. Most often, people never even find out they are low in IgA. My daughter, like you, falls just below normal range. She does have more than her fair share of common colds, throat infections, sinus infections, urinary tract infections, etc. As a child, she couldn't get a cold without it "turning" into a sinus infection, ear infection, etc. Have you been plagued by increased general illness or infections? How is it related to celiac disease? There is a higher prevalnce of IgA deficiency in those with celiac disease than in the general public, and there is a higher prevalence of celiac disease in those with IgA deficiency. Increased association both ways. The bigger issue in diagnostic testing for celiac disease is that any of the IgA tests used for celiac screening are not reliable measures in people who are IgA deficient. If you don't make IgA, you can't show IgA on these tests. So, then it is important to also test the IgG versions of the test... and it looks like they have done that. Quote:
However, there is another loophole I see, and it involves the Deamidated gliadin antibody. This is a newer test, replacing the original gliadin antibody test. The original gliadin antibody test was not considered specific to the finding of villous atrophy (required for a celiac disease diagnosis). The deamidiated gliadin antibody test was developed to be a better predictor of villous atrophy. The loophole is that you can have gluten sensitivity without having celiac disease. This is something gaining recognition over the past years, but not quite to the point of complete, widespread acceptance. So... on the one hand... in regard to predicting "celiac disease"... the deamidated gliadin test is a better test than the previous one. Step forward for diagnosing celiac disease (villous atrophy). This may help reduce the number of unnecessary biopsies. BUT... big BUT... when it comes to diagnosing gluten sensitivity that is manifesting without villous atrophy... the newer deamidated gliadin test becomes as worthless as the anti-tissue transglutaminase test (also very specific for villous atrophy). Neither of these tests will be positive unless someone has villous atrophy. You can absolutely be gluten sensitive and symptomatic without having villous atrophy; without being positive on these blood tests. Step backward for diagnosing gluten sensitivity. If your doctor is willing, try to get the original antigliadin antibody test ordered. You are more likely to test positive on the original gliadin antibody test than on the newer deamidated gliadin test. Still, you should now, many people who test negative even on the original antigliadin test often improve on a gluten free diet. The blood tests are not perfect. When it comes to gluten sensitivity without celiac disease, the rate of "false negative" lab results increase. Hence, the popularity of the stool test for identifying crytpic gluten sensitivity. It should be noted that even in cases of biopsy proven celiac disease, blood tests are negative in up to 20%. This is why if someone is highly symptomatic of celiac disease, they should be biopsied even when blood tests are negative. I know I just dumped a lot here. Please ask for clarification if it doesn't all make sense. Here are a couple of articles about IgA deficiency... keep in mind the distinction between IgA deficiency and Total IgA deficiency. Celiac Disease and Immunoglobulin A Deficiency... by Kumar, et al. Here are a couple others... the link was broken for the article I usually reference.. but this should help. http://pediatrics.about.com/od/prima...deficiency.htm http://www.nlm.nih.gov/medlineplus/e...cle/001476.htm It might not be a bad idea to test for IgG subclass deficiencies as well. And, here are some links to pages of The Gluten File that might help clarify some things on Gluten Sensitivity vs. Celiac Disease, Diagnostic Testing, etc. You can also scan the right bar for topics that may be of interest, particularly if there is any family history of other autoimmune disease. Diagnostic Testing The Gray Zone Limitations of Blood / Biopsy Gluten Sensitivity vs. Celiac Disease At Risk Population for Gluten Sensitivity/Celiac Disease Hope this helps! Cara I went gluten free primarily to support my daughter. My antibody tests were all negative. But, before long, a life time of nagging GI symptoms just vanished. I've also realized I am sensitive to cow's milk protein, too, as is my daughter. I say... if the shoe fits... wear it... I would absolutely recommend a gluten free diet if you are symptomatic in any way or have any family history of autoimmune disease! My family's story can be found in The Gluten File at the bottom of the home page, if you are interested. My family is gluten sensitive, but we do not have celiac disease.
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. Last edited by jccgf; 10-14-2009 at 12:40 PM. |
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10-14-2009, 10:57 AM | #4 | ||
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Senior Member (jccglutenfree)
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Selective IgA Deficiency -IDF Patient/ Family Handbook
Also on IgA deficiency affecting blood and stool testing: I have heard some doctors say you don't need to worry about IgA deficiency in celiac testing unless you are completely deficient (less than 7)... that you still make enough IgA for it to show up on the tests. I've heard other doctors, including one of the big specialists (but can't remember who) that below range IgA could affect those results. I would imagine it could go either way. I think you are right that the stool testing is also based on IgA testing, and can be false negative in IgA deficient people. I'm pretty Dr. Fine addresses the subject somewhere on his website, but I couldn't find it just now. I would think if you are not completely IgA deficient, you'd have a higher chance showing positive on the stool test than the blood test... just because it is a much more sensitive test... but that a false negative would be possible. But, that is just my opinion.
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. Last edited by jccgf; 10-14-2009 at 12:57 PM. |
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10-14-2009, 01:01 PM | #5 | ||
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Senior Member (jccglutenfree)
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Found it on the Enterolab website under FAQs:
https://www.enterolab.com/StaticPage...rpretation.htm Quote:
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10-15-2009, 06:47 AM | #6 | ||
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Magnate
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One day, there might be citizen prizes awarded to those non-medical people who have most advanced the public's understanding of medical conditions and gotten medical people to consider their usual mode of behavior and even change it in light of accumulated evidence.
There are a number of people who come to mind, such as the Lorenzo's oil couple, but I'm nominating jccgf right up there, even if The Gluten File is not as easily made into a movie. |
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