Gluten Challenge And Retest Questions

[kb27]

My son was diagnosed with celiac 3 years ago.  We (immediate family) were all tested and came up negative.  The specialist he went to said all immediate family members should be retested every 2-3 years.

 

Since we made the whole house gluten-free, none of the non-celiacs in the family each much gluten.  Thus, in order to get re-tested, we need to eat some.

 

Does anyone know what the current recommendations are for a gluten challenge?  I've seen everything from 4 pieces of bread for 6 weeks to a couple of crackers a day for 12 weeks.  Nobody will likely get sick doing this, so we don't need the bare minimum, but since all gluten is eaten outside the home, I don't really want to have to stuff 4 slices of bread in me every day at work if I don't have to.

 

Also - when we were originally tested, the doctor ran total IGA and ttg IGA.  Do we need both again?  Or is just ttg IGA enough?  (Total IGA #s were normal for everyone last time.) 

 

Thanks!

[kareng]

  On 2/22/2015 at 7:28 PM, kb27 said:

My son was diagnosed with celiac 3 years ago.  We (immediate family) were all tested and came up negative.  The specialist he went to said all immediate family members should be retested every 2-3 years.

 

Since we made the whole house gluten-free, none of the non-celiacs in the family each much gluten.  Thus, in order to get re-tested, we need to eat some.

 

Does anyone know what the current recommendations are for a gluten challenge?  I've seen everything from 4 pieces of bread for 6 weeks to a couple of crackers a day for 12 weeks.  Nobody will likely get sick doing this, so we don't need the bare minimum, but since all gluten is eaten outside the home, I don't really want to have to stuff 4 slices of bread in me every day at work if I don't have to.

 

Also - when we were originally tested, the doctor ran total IGA and ttg IGA.  Do we need both again?  Or is just ttg IGA enough?  (Total IGA #s were normal for everyone last time.) 

 

Thanks!

 

 

 

Open Original Shared Link

 

"A gluten challenge is the period of time when gluten is added back into a person’s diet to assist in the diagnosis of celiac disease. Antibodies take time to build into the blood stream before they can be detected through blood analysis. For a gluten challenge we recommend eating 1/2 slice of bread or a cracker each day for the duration of the challenge.

• Prior to blood testing we recommend 12 weeks of eating gluten.
• Prior to an endoscopic biopsy we recommend 2 weeks of eating gluten.

In the case of a severe reaction to gluten, a medical professional may opt to shorten the 12-week challenge and move immediately to an endoscopic biopsy."

[RMJ]

How nice of you to make the whole house gluten free for your son

[nvsmom]

I usually hear 1/2 to 2 slices of bread per day, or equivalent, for 8-12 weeks; eat 2 slices if doing a shorter challenge or less if a longer challenge.

 

The tTG igA is not enough, but you probably don't need to do the total IgA (control test) again if your ranges were well within normal limits.  Also get the tTG IgG, DGP IgA, DGP IgG, the EMA IgA (especially if a ttG test is positive), and possibly the older AGA IgA and AGA IgG if the DGP tests are unavailable.

 

All of those tests have a sensitivity that can be as low as 75% (lower in the AGA tests) which means it can miss up to 25% of all celiacs.  Running many tests increases your chances of catching the disease.  The DGP tests are the better ones for catching early celiac disease, and celiac disease in children, so push to get them run.

 

Page 12 of this report has stats on the sensitivity of the tests: Open Original Shared Link

 

Best wishes.