IgA

[mumtosarahlou]

My daughter was tested for celiac disease thru bloodwork. It showed that she is one of the small percentage of people who are IgA deficient so they cannot test for celiac disease this way. Does anyone know of another way to test for it? And is being IgA deficient a problem in any way? Her overall immune system seems very good. Thanks.

[annelb]

Hi mum - You are right, a low IgA means that all the IgA tests for CD may be worthless. The doctor can order IgG tests. There is a tTG IgG and an antigliadin IgG test. The tTG would be the one that correlates with celiac disease. The antigliadin IgG is less specific for CD(flat villi) but is more sensitive for gluten sensitivity. Sadly, many doctors have stopped ordering this more sensitive test because they are looking only for classic CD.

We often recommend Enterolab tests as they are very sensitive for gluten sensitivity - they do not tell you if you have flattened villi. But these tests are IgA tests too and may be not be accurate if the overall IgA is low.

Is your daughter having symptoms? There are times that a dietary trial will give you the best answer.

Have you looked at the Diagnostic Testing section of The Gluten File? You can find The Gluten File as a "sticky" at the top of the first page.

Often a low IgA will indicated problems with the immune system. Is she deficient in any of the other immunoglobulins? Here is a booklet on IgA deficiency. I know one precaution is that of blood transfusion. http://www.primaryimmune.org/pubs/book_pats/e_ch04.pdf

Hope this is of some help.

Anne

[mumtosarahlou]

Thankyou for that very informative link...sarah seems to have some discomfort after eating whole grain products which is why I asked for the testing....the blood transfusion thing is also interesting. She had 2 blood transfusions during her hip surgery 4 years ago-one from me and one from her half brother without any apparent troubles. Do you know if the IgA deficiency is genetic? Maybe some of us in the family have it. From reading the signs it seems like this half brother could have it. Sarah, on the other hand, is completely symptom-free. All her other IGs are in the normal range.

[mumtosarahlou]

Also, I forgot to say, her doc wants to do an endoscopy-is this a reliable way to test for celiac disease? I imagine this would include biopsies.

[Zonulin]

Hi Lesley!

My son (now 12) also has low levels of IgA - his last immunoglobulin panel showed 40, with the "normal" range from 80 - 450. His so-called immunologist said they don't worry unless it's 5 or lower, but his gastroenterologist insisted that he was "Iga Deficient," with mucosal membranes which are more vulnerable to infection and disease. He recommended that Ted wear a bracelet ID and that he not accept a blood transfusion unless the donor was also IgA Deficient...so there are two very different opinions. :confused: :rolleyes:

Based on his Antigliadin IgG antibody test (69, with a "normal" range topping out at 20), he had an endoscopy. The biopsies showed no flattened villi. Of course you already know that flattened villi occurs during late-state celiac disease. Not sure I would advise you to press for the endoscopy. Ted was later found to have H. pylori (a bacterium that lives in the stomach lining), an ELISA reaction to 25 different foods, elevated levels of mercury and lead, and a lack of acetylcholine (necessary for releasing digestive enzymes, among other things).

Some people go through life without knowing they are IgA Deficient (or having low levels of IgA). Others are naturally more vulnerable to infection and disease because of it...

Karen

[jcc]

My daughter was tested for celiac disease thru bloodwork. It showed that she is one of the small percentage of people who are IgA deficient so they cannot test for celiac disease this way. Does anyone know of another way to test for it? And is being IgA deficient a problem in any way? Her overall immune system seems very good. Thanks.

I'd next ask for the anti-tTG IgG and antigliadin IgG blood tests as the next step, and maybe the genetic testing as well. I'm glad to hear that they tested for IgA deficiency, because many people have fallen through the diagnostic cracks because there tests were false negative due to IgA deficiency. As mentioned, they can run the "IgG" version of these tests.

From what I understand the transfusion problem is only a problem for those in the extremely low range...I've read below 7, but obviously there seems to be some variance of opinion from the doctors.

If you haven't had a chace to look through The Gluten File yet, you might want to read the Diagnostic Testing pages.

A biopsy is the current 'gold standard' testing for celiac disease, but so many people with a negative biopsy still benefit from a gluten free diet.

Cara

[mumtosarahlou]

I'm going to email her doc and ask for the specific numerical value they got for her IgA...this will be helpful...does it run in families(the low IgA?)

[Zonulin]

Check out #5 and #6 on this link: http://www.medscape.com/viewarticle/507233_3 Seem to be a bunch of articles online which indicate that this is genetic. Also seems to be some data re IgA deficiency accompanied by normal IgG and IgM versus having the entire immunoglobulin panel low (as occurred with my son). His immune system was compromised, since his entire panel was below the starting range. :( So there's some more confusing information to ponder...

Karen

[uvamomb]

Endoscopy is the best way to test for celiac to get a definitive answer - bloodwork often misses it from what I'm told. So, good luck with that.
I'm more familiar with IGG deficiency - as my son had that, but seems his "A" was low as well. At the very least, this should lead to furhter testing in your daughter. Have your consulted an immunologist? Please let us know how things go for her.

Take care of yourself as well,
Kathy

[jcc]

Thanks for making that point, Kathy. Some studies have shown up to 20% of biopsy proven celiacs have negative blood work, so it is quite possible to have all negative bloodwork and a positive biopsy. I think a fair number of celiacs are probably still being missed because they are being dismissed too soon based on negative blood work, not to mention those missed because they have a "non-celiac" gluten sensitivity.

Cara

[mumtosarahlou]

So Sarah's IgA level was 35 (normal range 70-312). Her IgG, IgE and IgM levels were all normal so I think she has "selective IgA deficiency". Would an Immunologist consult be appropriate/necessary do you think with only this one low Ig level? She is rarely sick. As far as possible blood transfusions...I think it would be better to error on the safe side and request blood that is also IgA deficient. Do they test all blood for this in general?
This is all so interesting...

[annelb]

I am confused. According to the article Karen found(good find :) ) the IgA has to be less than 7mg/dl to be considered IgA deficient and less than .5 to worry about transfusion problems.

If above 7 is not IgA deficient, then why is the range from your child's lab 70-312? What units were used? Was it mg/dl?
Anne

[jcc]

Anne,

We've had a few past discussions about total/complete IgA deficiency and "less than total/complete" IgA deficiency. While some doctors only consider it to be noteworthy if it is total (< 7), others have indicated that 'low' IgA deficiency may affect general health, and certainly CAN affect celiac blood test results.


I think this is CONFUSING, and that there are differing opinions. Somewhere, I did see this distinction discussed in 'article' form, but I can't begin to remember where. Might very well have been in one the two articles I keep in TGF. I'm wondering if there is a difference in terminology used to distinguish between complete IgA deficiency and low IgA.

I think Judy and Karen might a better understanding (or better memory :)) here, and I think they both check in here...so hopefully they may have further input. Well, Karen has already posted to this thread, but maybe she will have more :).

Cara

[mumtosarahlou]

I don't know what units were used is Sarah's lab values. Her GI guy told me hers (35) was a "low" number but since she presents with few infections, etc. that she was handling it well and not to worry. So I consider her "deficient" in IgA rather than having no IgA. Her value is above 7 so it's not extremely low. But it is there nonetheless and because of this apparently has a higher risk of Celiac Disease and auto immune diseases in her future.
This is what I have read in the past couple of days....if I understand it correctly-lol

[halsgluten]

But these tests are IgA tests too and may be not be accurate if the overall IgA is low.

Anne

Enterolab represents their test as capable of detecting gluten sensitivity when the blood test miss it.

I started the GFD under the presumption that the only test that mattered was clinical improvement of whatever symptoms you had. I still advise that, but after blood then stool tests if you can afford them, and have symptoms you can track (any). I couldn't afford them, and an MD friend who is a Celiac said he'd thrown his useless blood test kit away, so I went GF pre-test.

I imagine it is easier to go GF with a positive test, but with do-overs, I wouldn't want to wait for enough damage to become symptomatic.

But, I have recently given thought to listing conditions that are at not gluten sensitive, but never-the-less show clinical improvement on the GFD, these are generally most any problem with the liver, pancreas, gallbladder or small intestine. Gi’me some time and I’ll do it.

Hal

[jcc]

Gi’me some time and I’ll do it.



You got it! :D

I think that Enterolab does say they have the same problem with IgA deficiency. The stool tests will be positive long before the blood tests in people who make IgA, but in those who are IgA deficient...it doesn't show in the stool either. I'm pretty sure I remember this, but it's been a long time. I'll try to go find it on their website. Here we go:


What does it mean that my antigliadin antibody level is just below the upper limit of normal?
All clinical laboratory tests must define a normal range that best distinguishes those with disease from those without. Depending on what range is used to define normal will determine how many people with disease will fall into the normal range, and conversely, how many people without disease will fall into the abnormal range. Our determined cut off for normal of 10 Units was derived after years of comparing antibody levels with gene and malabsorptive test results, as well as clinical histories before and after treatment with a gluten free diet. Although our stool test is multitudes more sensitive in picking up gluten sensitivity than blood tests, no single diagnostic test can rule out gluten sensitivity with 100% certainty (we estimate our antibody test misses about 1 in 500, about equal to the frequency of IgA deficiency in the general population). Thus, while it is very unlikely that a person with an antigliadin antibody level in the normal range has active gluten sensitivity, anyone with symptoms of gluten sensitivity and/or having an autoimmune disease, especially if accompanied by an antibody level just below the cut off, or with a gluten sensitive gene and/or intestinal malabsorption, should consider a 6-12 month trial of a gluten free diet, looking for improvement in symptoms, autoimmune disease severity, and/or intestinal malabsorption. It is only in this population that a gluten free diet should be considered a "trial"; all other people must consider gluten-free diet for positive tests definite and permanent therapy.
https://www.enterolab.com/StaticPages/Faq_Result_Interpretation.htm

What is the numeric range of positive antigliadin antibody results?
Our antibody tests range numerically from a positive value of 10 to as high as 350 Units. The average positive value is about 45 Units. The "units" are based on the amount of antibody detected in the assay which is reflected by more color developing as the result of a color-generating chemical reaction. Thus, the more antibody present, the higher the units of positivity. However, the amount of antibody present is not a measure of clinical severity, but rather, the amount of antibody being produced by the plasma cells in the intestine in response to gluten at that site. A positive value of any degree means your immune system is reacting to dietary gluten in the way the immune system reacts to an infection. With an infection, this immune reaction ultimately kills and clears the infectious organism. But with gluten, the reaction continues as long as it is eaten. Thus, the only way to halt this immune reaction is to remove all gluten from the diet. This is true whether your positive test is 10 units, 350 units, or anything in between.



Cara

[Zonulin]

I am sorry to say that the Medscape link I posted just dumps you into their main page, which asks you to register :( But it's article 507233, if anyone has already registered...I don't remember WHAT I googled to find that article :confused: :rolleyes: Apologies to all. That said, I've spent maybe 45 minutes googling "heredity +'IgA deficiency'" but have yet to run across that article again. But I did discover many references to "hereditary IgA Deficiency" and then there's "selective IgA Deficiency" versus plain old "IgA Deficiency" ("selective" means that only the IgA is low, and all other immunoglobulin levels are normal). It looks as though it certainly could be an inherited trait, and this makes me want to have my own immunoglobulin panel done so I can clearly see whether I am the culprit in some of my son's health problems :eek:

I did find this on a South African site which clearly explains which of the celiac panel tests are affected by an IgA Deficiency (most of you already know this stuff, but this is for the newbies):

How is Coeliac Disease diagnosed?
There are a range of blood tests that have been introduced internationally over the past few years that can be used to support the diagnosis of CD.

1. The anti-gliadin antibody (AGA) assays
(a) for IgA against gliadin, that measures the amount of IgA antibody produced against the gliadin component of cereals (b) for IgG against gliadin, that measures the amount of IgG antibody produced against the gliadin component of cereals.
2. The anti-reticulin antibody (ARA) test, (that is based on IgG antibodies seen in an Immuno-Fluorescent microscope examination)
3. The anti-endomysial antibody (AEA) assay, that identifies IgA antibodies against the endomysium tissue.
These tests offer simple and fast tools to investigate patients with suspected CD. They are particularly recommended for selected screening of risk groups, such as relatives of CD patients, undiscovered CD patients, and patients who are affected by a related disease such as malabsorption or diabetes mellitus. These tests, and in particular the AGA assays, are also very useful in monitoring the compliance to a gluten-free diet, as any increase in the levels of the antibodies indicates exposure to gliadin in the diet.

Here's the link to the entire site, if you want to read more (cross yer fingers): www.allergysa.org/coeliac.htm Thanks for the heads-up, Claire!! :D

Karen

[jcc]

I recommend registering for Medscape. It's free, and once you are registered...you pop right into the article. I landed right where I was supposed. However, the downside of Medscape is that the links frequently expire. So long as you have the Title of the article, you can search it while in Medscape.

Here is a page of other Celiac related articles on Medscape:
http://jccglutenfree.googlepages.com/medscapearticles

Oh...did you guys need the title of the IgA article? I suppose the number stays static as well? Just the address doesn't?

A Patient With a Low IgA Level Requiring Transfusion During CABG

5. The most common illnesses associated with IgA deficiency are recurrent sinopulmonary infections, including sinusitis, otitis media, pharyngitis, bronchitis, and bronchopneumonia. Gastrointestinal tract disorders may also be associated with selective IgA deficiency, including a 10-fold increased risk of celiac disease, pernicious anemia, milk intolerance, malabsorption syndrome, and mucosal infections due to acute diarrhea caused by bacteria, viruses, or Giardia lamblia.[6]

Sounds like mom and children in my family. Of all of us, only one daughter has been actually tested...and she is just below range, low IgA but not IgA deficient.

Cara

[Electra375]

I thought I would add my conclusions about the IGA issue from my experience with my ds2. I too found it confusing, but then more unsettling due to the variations of labs and results.
Our first round of CD tests were the TTG with total IGA done by the Mayo Clinic. The value of his IGA came in at 23 (I'm going on memory here) with a range of 8 to some number like 400ish. With that it would appear he was not low in IGA and the pediatrician was stumped.
After all the reading I had been doing I decided to go ahead and see a Pedi GI. He ordered the entire CD panel from Prometheus labs including the gene tests. Those results came back with his Total IGA at 26, but the ranges were now classified by age. He fell below his age range normal. Still this Pedi GI did not give enough weight to his IGA being low, to him all he saw was his CD panel except for IGG and having a necessary gene were all negative.
I was not happy with this and I wanted answers after reading about the seriousness of IGA deficiency. I took my ds2 to see Dr Fasano. Dr. Fasano recognized right away that my ds2's levels of IGA were too low to have given any merit to the CD panel. He also knows the statistics of Celiacs with low to no IGA, statistically speaking a child with low IGA & possitive genes for Celiacs is more than likely a Celiac regardless of the other test including the IGG which my ds2 was very high even 54 days after starting the GF diet.
Lab to lab and doctor to doctor there is no set standard -- this is the frustrating part and also unsettling b/c how many people are falling through the cracks.
I wish they would do more research in diagnostic techinques for CD than working on some drug...

BTW - My ds2 is a very healthy kid, but then again he may not show symptoms of something more serious in the event he ever go something. He has never had antibiotics which I understand may not have helped anyway given his intestinal status prior to GF and the IGA issue. From what I understand as an example: An IGA deficient person who has measles may not present with all the symptoms, they may have sensitivity to light and red eyes, fever, but no rash or those pustuals in the mouth or they might have all the symptoms or none... I also am going to guess with logic that the level of absent symptoms of any illness would be in equal realtion to how deficient the individual is in IGA at the time.

It is all very interesting and I don't believe many doctors in standard practice "get" it. I seem to know more about IGA deficiency than our pediatrician or pedi GI, that is sad. If you see an immunologist, report back what you find out, I'd be very curious. I think IGA deficiency is genetic to some degree, however, while my dh and ds1 are DQ2 their IGA levels are fine as are mine -- so where did it come from, is it recessive. I asked and know DQ2 is not recessive.