Please help me understand these results; celiac reflex panel?

[Doityerself]

Hey all, I'm new here but not new to celiac. Wheat intolerances are all over the place in my family  as well as AI thyroid issues (Hashis). When my CRO and ESR rates were extremely high, my doctor suggested it could be gluten/dairy and I was gluten free for the better part of a year. I've been tested in the past twice, once with a "false positive" and one totally negative. Going gluten free didn't help my inflammation rates go down (they went up actually) and I became more lenient with my diet recently because of the nature of my work (I'm a chef), with little negative effect. At my last appointment, I confessed to having had eaten gluten with no real issue for the past several weeks, and when the doctor prescribed other blood work I wanted a celiac panel "just in case" but we both agreed they'd all be negative. 

WELP I just got my results back via email, and the primary panel came back all within normal range, but the celiac reflex panel came back positive  my results are posted below  I've googled what a celiac reflex panel is and haven't come up with anything, I've searched these forums and others and can't find anything that even really explains what this test is. I'd love some help understanding the different tests as well as my results. Thank you in advance! 

 

 

 

Ps, it looks like my crop job lopped off the top result, but for those who can't tell, the result is Anti-Gliadin Ab Iga 7 

 

Thanks again!

 

 

 

[GFinDC]

Hi Doit,

The reference ranges to the right of the test result show the values the result ought to be in for normal readings (no celiac disease).  Your results appear to show no higher than normal results that I can see.

However, you aren't following the recommended process for celiac disease blood testing.  The blood test is supposed to preceded by 12 weeks of daily gluten eating.  That is generally enough time to cause a sufficient quantity of antibodies to build up in the blood stream to be detectable by the tests.

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Not having antibodies in the blood stream doesn't mean you aren't being damaged.  People with DH (dermatitis herpetiformis) sometimes test negative on the standard blood tests.  My theory is possibly because the antibodies are concentrated in the skin instead of the blood.  In gut damage, it is possible the antibodies are concentrated in the gut, instead of the blood.  After some time they show up in the blood also.  The thinking is the antibodies go where the work is.  Anyway, theories aside, it takes very little gluten to kick off an immune response.  Those antibodies are not aimless soldiers.  They start doing their work and destroying gluten and gut tissue even if you don't feel symptoms.  Did you know there are some people who have no GI symptoms of celiac disease but still have it?  They call that silent celiac.  So going by symptoms is not a good way to judge actual damage in the gut.

You are wise to go in for followup testing, but the followup testing is hopefully to show compliance with the gluten-free diet, and lower antibody test results.  Have your close family members been tested for celiac disease?  It sounds like they should be.   There is a 5% higher chance of them having celiac than the general population.

Welcome to the forum!

[Doityerself]

Thanks for yoUr response GFinDC. For what it's worth,  I've eaten gluten daily for at a minimum of 10 weeks now. I have to taste at work, and initiallyni noticed no ill effect until after I'd been consuming it regularly over a period of time. Shortly before I initially went gluten free, I was suffering from unexplainable stomach cramping and issues that did go away when I quit gluten. It didn't come back until just the past couple of weeks though and now I'm remembering how painful, uncomfortable, and smelly the whole situation was ? 

 

Can you explain what the reflex test (the one I tested above range in) is? 

[GFinDC]

Sorry Doit,

Ok, I think I see what you are talking about.  The serum IgA test?  The serum IgA is to verify if your body does make IgA antibodies.  Not all of us make that particular antibody type.  you do make IgA antibodies though, and your reading is fairly high.  the way I understand it, the serum IgA is not specific to celiac disease.  It does indicate a level of antibody activity though.  So perhaps you are fighting an infection or something?  Or it is celiac and for some reason your blood levels of antibodies are not high enough to detect right now.

The below info on serum IgA is from Quest Labs.

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Test Highlight

IgA, Serum

Clinical Use

Diagnose IgA deficiencies Determine etiology of recurrent infections Diagnose infection Diagnose inflammation Diagnose IgA monoclonal gammopathy

Clinical Background

IgA is the first line of defense for the majority of infections at mucosal surfaces and consists of 2 subclasses. IgA1 is the dominant subclass, accounting for 80% to 90% of total serum IgA and greater than half of the IgA in secretions such as milk, saliva, and tears. IgA2, on the other hand, is more concentrated in secretions than in blood. IgA2 is more resistant to proteolytic cleavage and may be more functionally active than IgA1. IgA deficiency is the most prevalent isotype deficiency, occurring in 1/400 to 1/700 individuals. Many patients with IgA deficiency are asymptomatic, while others may develop allergic disease, repeated sinopulmonary or gastroenterologic infections, and/or autoimmune disease. Individuals with complete absence of IgA (<5 mg/dL) may develop autoantibodies to IgA after blood or intravenous immunoglobulin infusions and may experience anaphylaxis on repeat exposure. Elevated serum IgA levels are associated with infection, inflammation, or IgA monoclonal gammopathy.

Method

In this nephelometric method, anti-human IgA binds to IgA in the patient sample, forming an insoluble complex. The amount of light scattered by this insoluble complex is proportional to the concentration of IgA present in the sample.

 

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[Doityerself]

Ok, that was my understanding of it too after some reading, but the fact that the result was under "celiac reflex panel" is what confused me. 

 

I do have some unspecified autoimmune activity going on in my body. My inflammation levels are very high, my complement testing has come back off, and nobody really knows why. A total high Iga isn't a surprise in this case if it doesn't actually hab anything to do with gluten. Going gluten free made my inflammation markers rise rather than go down, so I'm inclined to believe I'm mostly okay with gluten, aside from some digestive issues that I believe are simply from the wheat not being fermented. Sourdough causes me no issue,  but soft white bread destroys me for example. Anyways, It's all very confusing and I wish I knew what the heck was going on with my body. 

[GFinDC]

Hi DoitY,

I also think the reflex teminology is confusing in this case.  I read on another testing site that the reflex tests are done when the total IgA is low.  In that case they perform the IgG antibody tests and call it a reflex test.  Different site though so they may not use the terminology the same way.  Your total IgA is not low so that's why the reflex terminology is confusing I think.

And so we stumble forward through life... 

Maybe someone else has a better explanation of the term reflex panel?

[plumbago]

Your test results, to me, seem to indicate that you do not have celiac disease. (Everything is within normal levels.)

And, your total IgA is high. Many people with celiac disease have low total IgA levels (10-15 times more frequently than people in the general population). The total IgA is conducted because about 3% of people are IgA deficient. If you have a very low total IgA, that can invalidate the three blood tests that rely on your IgA levels.

 

Plumbago

[RMJ]

In reflex testing they look at a result and decide if the next test is needed.  Another example, some labs only do EMA if the Ttg is positive.