Lab results question

[LindsRF]

Hello! 

My son recently had a Celiac Panel done. He was Immunoglobulin A deficient, and his tTG IgG was positive. Deamidated Gliadin was in range as well as tTG IgA was also in range. I know we can go to a pediatric GI and get an upper endo for confirmed diagnosis, however I was wanting to see if anyone was familiar with these results. If these results are more indicative of celiac, I would rather just go gluten free and not have him put under anesthesia for the scope. Thanks

[Scott Adams]

Is there any way you can share the actual levels in his results? Normally a positive tTG IgG means that gatro follow up should be done to confirm the diagnosis.

[cyclinglady]

It only takes one positive for him to be referred to a GI.  Consider talking to the GI first before you decide to have him go gluten free.  The antibodies tests are not perfect and biopsies are still the gold standard in diagnosing celiac disease.  Still.  Celiacs can have concurrent illnesses as well.  It can be valuable to have a benchmark.  

A firm diagnosis can be necessary for schools to accommodate his dietary needs (e.g. like no PlayDoh in the classroom, etc).  Later it could necessary for university dorm life.  It can also help kids stick to the diet which is a lifelong commitment, as you already know.  

Read through other parent member’s comments.  Almost all are glad they had the endoscopy.  Maybe it is actually all.  Some do not, but usually it is a financial issue, lack of access to a GI or the child is so ill that the medical team decides not to scope but that is rare.  

[LindsRF]

On 11/26/2019 at 2:44 PM, Scott Adams said:

Is there any way you can share the actual levels in his results? Normally a positive tTG IgG means that gatro follow up should be done to confirm the diagnosis.

Yes his immunoglobulin a was 47 and confirmed on a repeat test the lab did. Then his ttg igg was 17. I tried to upload a photo but it wouldn’t let me 

[cyclinglady]

His Immunoglobulin A might be low (no lab ranges provided) but from what I know, it is plenty to insure that any IgA celiac test (EMA, DGP, or TTG) should in theory work.  The Immunoglobulin A test, when used for celiac disease testing, is just a control test.   It would have to be close to zero for the celiac IgA tests to be questioned (See link below).   There are a few celiacs who are seronegative and some test funny (like me).   Your son’s TTG result is not common.  It falls into a grey area.  It is why you should consult with a GI and follow-up with an endoscopy if recommended.  

“Per Dr. Daniel Leffler, a celiac gastroenterologist at Beth Israel Deaconess Medical Center, it is important to note that while the modern celiac blood tests (tTG and DGP) are very accurate, they are not perfect. Some patients will have active celiac disease with a negative test or a false positive result (the test is positive but they either don’t have celiac disease or their celiac disease is well controlled).   A gastroenterologist skilled in celiac disease can help to sort through the sometimes challenging blood work results.”

https://nationalceliac.org/celiac-disease-questions/interpreting-a-high-igg-and-negative-iga-test-result/

“If IgA is below detection (<1.0 mg/dL), then tTG IgG and deamidated gliadin IgG will be performed at an additional charge.”

https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/89199

Edited December 1, 2019 by cyclinglady