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  • Jefferson Adams
    Jefferson Adams

    New Blood Test Will Spot Celiac Disease Without Gluten Consumption

    Reviewed and edited by a celiac disease expert.

    Anyone who has ever tried to get an official diagnosis for celiac disease has likely experienced one very unpleasant reality: Having to eat wheat for 6-8 weeks to make sure the antibody tests are accurate.

    New Blood Test Will Spot Celiac Disease Without Gluten Consumption - Photo: CC--Vladimer Shioshvili
    Caption: Photo: CC--Vladimer Shioshvili

    Celiac.com 01/22/2018 - Celiac disease is marked by HLA-DQ2/8-restricted responses of CD4+ T cells to gluten from wheat, barley or rye.

    Currently, in order to properly diagnose celiac disease based on serology and duodenal histology doctors need patients to be on gluten-containing diets. This is a problem for many people, who prefer not to begin ingesting wheat again once they have adopted a gluten-free diet. This can present challenges for doctors attempting to diagnose celiac disease.

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    It is known that HLA-DQ–gluten tetramers can be used to detect gluten-specific T cells in the blood of patients with celiac disease, even if they are on a gluten-free diet. The team set out to determine if an HLA-DQ–gluten tetramer-based assay can accurately identify patients with celiac disease.

    The research team included Vikas K. Sarna, Knut E.A. Lundin, Lars Mørkrid, Shuo-Wang Qiao, Ludvig M. Sollid, and Asbjørn Christophersen. They are variously affiliated with the Department of Immunology, Oslo University Hospital – Rikshospitalet, Norway; the KG Jebsen Coeliac Disease Research Centre, University of Oslo, Norway; the Department of Gastroenterology, Oslo University Hospital – Rikshospitalet, Norway; the Department of Medical Biochemistry, Oslo University Hospital – Rikshospitalet, Norway; and with the Centre for Immune Regulation, Oslo University Hospital – Rikshospitalet and University of Oslo, Norway.

    For their study, the team produced HLA-DQ–gluten tetramers and added them to peripheral blood mononuclear cells isolated from 143 HLA-DQ2.5+ subjects. There were a total of 62 subjects with celiac disease on a gluten-free diet, 19 subjects without celiac disease on a gluten-free diet due to perceived sensitivity, 10 subjects with celiac disease on a non-gluten-free diet, and 52 seemingly healthy individuals as control subjects.

    The team used flow cytometry to measure T cells that bound HLA-DQ–gluten tetramers. They then used researchers blinded to sample type, except for samples from subjects with celiac disease on a gluten-containing diet, to conduct laboratory tests and flow cytometry gating analyses. They also conducted analysis on test precision using samples from 10 subjects.

    They found that an HLA-DQ–gluten tetramer-based test that detects gluten-reactive T cells identifies patients with and without celiac disease with a high level of accuracy, regardless of whether patients are on a gluten-free diet.

    This test could conceivably allow celiac diagnosis while suspected patients are still on a gluten-free diet. The team notes that their results require a larger study for validation.

    Could reliable celiac diagnosis be done without making patients consume gluten? Will that become common? Stay tuned for more developments.

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    Guest AWOL cast iron stomach

    Posted

    Hope this test becomes available sooner than later. It is very much needed.

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    Guest mrister

    Posted

    Sounds promising and a great development, but this brings up the point that you should not self-diagnose celiac disease. If you work out, by your own process of elimination, that gluten is problematic for you, rather than self-diagnose and put yourself on a gluten free diet, you should immediately visit your doctor and go through the correct process to diagnose celiac disease. Most people don't know, that when you cut gluten out of your diet, you cease to produce the gluten antibodies your doctor would be looking for as part of your diagnosis. This makes it very hard to diagnose unless you start eating gluten again. Plus there are other things your doctor needs to keep an eye on, which won't be happening if you self-diagnose.

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    Guest Stephanie

    Posted

    This sounds promising. I would like to know what the rate of false negatives ends up being and whether there is a positive correlation with false negatives and the length of time on a gluten-free diet.

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    Guest Emily
    Sounds promising and a great development, but this brings up the point that you should not self-diagnose celiac disease. If you work out, by your own process of elimination, that gluten is problematic for you, rather than self-diagnose and put yourself on a gluten free diet, you should immediately visit your doctor and go through the correct process to diagnose celiac disease. Most people don't know, that when you cut gluten out of your diet, you cease to produce the gluten antibodies your doctor would be looking for as part of your diagnosis. This makes it very hard to diagnose unless you start eating gluten again. Plus there are other things your doctor needs to keep an eye on, which won't be happening if you self-diagnose.

    I was self diagnosed by my mother 13 years ago. There wasn't a lot of option back in 2005, if any, like there are now. Going back on a gluten diet isn't an option for me as I have a very severe reaction to it. There really isn't an option for me besides hoping this new test for celiac disease is successful. You're very right if someone has recently realized they might have a gluten sensitivity or intolerance.

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    Guest NicholasG

    Posted

    Does anyone know if there are any updates or follow up studies in process?

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    Scott Adams

    We do not know, but will post a summary of any research that follows this up.

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    Catt

    Is this test available yet to NHS or privately?

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    trents

    This study is over two years old now and I have not heard of any follow-up studies to verify results. You would think other researchers would pick up on this, given the accuracy of the initial research results.

    Edited by trents
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    Guest NicholasG

    Posted

    On 3/14/2021 at 4:08 AM, trents said:

    This study is over two years old now and I have not heard of any follow-up studies to verify results. You would think other researchers would pick up on this, given the accuracy of the initial research results.

    Yah, it looks really promising so it's frustrating that this hasn't been followed up at all (to my knowledge). I'm guessing the world obsession with  covid has sadly restricted many other important medical research projects.

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    Guest crstlgls

    Posted

    I am getting HLA-DQ testing next week because I found out my sibling has Celiac disease. I get smelly diarrhea, headaches, and abdominal pain from gluten. I also have intolerances to fructose, fructans, and lactose. I am hoping I can be diagnosed without having to eat gluten again because it makes me really sick. Otherwise, I will do the other tests in summer when I am off from college classes again.

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    trents
    28 minutes ago, Guest crstlgls said:

    I am getting HLA-DQ testing next week because I found out my sibling has Celiac disease. I get smelly diarrhea, headaches, and abdominal pain from gluten. I also have intolerances to fructose, fructans, and lactose. I am hoping I can be diagnosed without having to eat gluten again because it makes me really sick. Otherwise, I will do the other tests in summer when I am off from college classes again.

    Both kinds of celiac diagnositc tests (serum antibody and biopsy) require consumption of regular amounts gluten for weeks or months leading up to the testing. The Mayo Clinic guidelines are the daily consumption of two slices of wheat bread or the gluten equivalent for 6-8 weeks leading up to serum antibody testing and for two weeks leading up to the endoscopy/biopsy. The antibody testing is usually done first and the biopsy is followup for confirmation. If you go off gluten ahead of time, healing of the villi that line the small bowel starts to happen and inflammation markers (antibodies) go down. Test results will be invalidated if you start eating gluten free ahead of time.

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    Guest crstlgls

    Posted

    My sibling could not do the gluten challenge because her reaction to gluten is so severe she could not work. She has 2 kids and a house to take care of. They just ruled out gluten allergy with her. Because of my intolerances, I cannot digest the fructans in wheat either. So even if I do it, I won't know if it's the gluten or the fructans bothering me because both will to some degree. My provider is trying to avoid it with me because it won't tell me something I do not already know and I have been gluten-free for years. I might end up paying for this newer test myself if Medicare does not, but at least I will know if I am susceptible to it.

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  • About Me

    Jefferson Adams

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University. His articles, essays, poems, stories and book reviews have appeared in numerous magazines, journals, and websites, including North American Project, Antioch Review, Caliban, Mississippi Review, Slate, and more. He is the author of more than 2,500 articles on celiac disease. His university coursework includes studies in science, scientific methodology, biology, anatomy, physiology, medicine, logic, and advanced research. He previously devised health and medical content for Colgate, Dove, Pfizer, Sharecare, Walgreens, and more. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of numerous books, including "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

    >VIEW ALL ARTICLES BY JEFFERSON ADAMS

     


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