Test result interpretation negative TISSUE TRANSGLUTAMINASE AB, IGA (tTG-IGA) , positive DGLIADIN (DEAMIDATED) AB (IGG) [DGP-IGG]

[Victor2022]

Hi

4 years Child has following blood test results ( only DGP-IGG High)

and has no symptoms like no skin rash, no constipation, no diarrhea, no bloating, no gas, no pain in abdomen, stool is normal and growth is normal. 

TISSUE TRANSGLUTAMINASE AB, IGA 1.6 U/mL (Range <15.0 Antibody not detected & > or = 15.0 Antibody detected)
GLIADIN (DEAMIDATED) AB (IGA) <1.0 U/mL (Range <15.0 Antibody not detected & > or = 15.0 Antibody detected)
GLIADIN (DEAMIDATED) AB (IGG) 18.9 H U/mL (Range <15.0 Antibody not detected & > or = 15.0 Antibody detected)
IMMUNOGLOBULIN A 97 Reference Range: 22-140 mg/dL

Can anyone please interpret it? is it a celiac disease ?

[trents]

Positive DGP-IGG could point to celiac disease but could also be due to other medical issues. The first line celiac antibody tests physicians usually order is the tTG-IGA. It is very reliable on adults but not on young children. That's where secondary tests which are less specific for celiac disease are helpful, like the DGP-IGG. One test that should have been run and wasn't is total IGA. If total IGA is low it often results in a negative TTG-IGA.

If in fact your child has celiac disease the reason he has no symptoms may be that it was caught early before much damage to the small bowel villi was done.

But if the child has no symptoms, I'm curious as to what led to his/her testing for celiac disease. Is there family history of it?

Has your physician spoken to you about the option of an endoscopy/biopsy of the small bowel lining? This is usually done for confirmation when there is a positive antibody test result. Beware that if further testing is planned, you should keep the child eating regular amounts of gluten.

[Wheatwacked]

Here is an article about non traditional symptoms. There are more than one would think? https://www.celiac.com/articles.html/what-are-the-symptoms-of-celiac-disease-r1090

Edited May 15, 2023 by Wheatwacked

[Victor2022]

21 minutes ago, Victor2022 said:

Hi

4 years Child has following blood test results ( only DGP-IGG High)

and has no symptoms like no skin rash, no constipation, no diarrhea, no bloating, no gas, no pain in abdomen, stool is normal and growth is normal. BUT lost 4 LB in last one year (Child is still in >95 percentile range for height and weight)

TISSUE TRANSGLUTAMINASE AB, IGA 1.6 U/mL (Range <15.0 Antibody not detected & > or = 15.0 Antibody detected)
GLIADIN (DEAMIDATED) AB (IGA) <1.0 U/mL (Range <15.0 Antibody not detected & > or = 15.0 Antibody detected)
GLIADIN (DEAMIDATED) AB (IGG) 18.9 H U/mL (Range <15.0 Antibody not detected & > or = 15.0 Antibody detected)
IMMUNOGLOBULIN A 97 Reference Range: 22-140 mg/dL

Can anyone please interpret it? is it a celiac disease ?

 

 

11 minutes ago, Wheatwacked said:

Here is an article about non traditional symptoms. There are more than one would think? https://www.celiac.com/articles.html/what-are-the-symptoms-of-celiac-disease-r1090

 

13 minutes ago, trents said:

Positive DGP-IGG could point to celiac disease but could also be due to other medical issues. The first line celiac antibody tests physicians usually order is the tTG-IGA. It is very reliable on adults but not on young children. That's where secondary tests which are less specific for celiac disease are helpful, like the DGP-IGG. One test that should have been run and wasn't is total IGA. If total IGA is low it often results in a negative TTG-IGA.

If in fact your child has celiac disease the reason he has no symptoms may be that it was caught early before much damage to the small bowel villi was done.

But if the child has no symptoms, I'm curious as to what led to his/her testing for celiac disease. Is there family history of it?

Has your physician spoken to you about the option of an endoscopy/biopsy of the small bowel lining? This is usually done for confirmation when there is a positive antibody test result. Beware that if further testing is planned, you should keep the child eating regular amounts of gluten.

Child lost 4 LB in last one year (Child is still in >95 percentile range for height and weight)

[Victor2022]

25 minutes ago, trents said:

total IGA

Total IGA= is the same as IgA (IMMUNOGLOBULIN A) = 97 [Reference Range: 22-140 mg/dL], just confirmed on the Lab site

[Victor2022]

37 minutes ago, trents said:

family history

No KNOWN Family History of celiac disease

[Victor2022]

40 minutes ago, trents said:

Positive DGP-IGG

Positive DGP-IGG....... Is that Positive DGP-IGG is  "non-celiac gluten sensitivity (NCGS)/ Wheat Sensitivity" or it is considered as Celiac disease?

[Wheatwacked]

NCGS is the diagnosis after Celiac has been ruled out but the patient shows improvement on GFD, then reversal with reintroduction of gluten.  Current rate for Celiac is ~1% and NCGS is 10%.  Some researchers and doctors consider NCGS like pre-Celiac. Regardless, both are treated with abstenance from Wheat, Rye, Barley and replenishment of low essential vitamin and minerals.

When my son was diagnosed when he was weaned the doctor insisted on only Nutramigen Infant as it was the most hypoallergenic and complete nutrition. One of the only ones with Choline.  He quickly recovered and grew up strong.  Ask a doctor if appropriate for your son.

Nutramigen with Enflora LGG Toddler Formula

[trents]

7 hours ago, Victor2022 said:

Total IGA= is the same as IgA (IMMUNOGLOBULIN A) = 97 [Reference Range: 22-140 mg/dL], just confirmed on the Lab site

Yep. Sorry, I missed that one. Ditto to what Wheatwacked said about NCGS.

[Scott Adams]

The article below has more info about the DGP-IgG blood test for celiac disease. The odds are that the child may have celiac disease, and you may want to consider an endoscopy to confirm this. If the biopsy were negative it could still indicate non-celiac gluten sensitivity, but the child definitely has an abnormal autoimmune response to gluten:

Quote

The sensitivity of the DGP-IgG test is reported to range from 75% to 85%, which means it can correctly identify individuals with the condition in about 75% to 85% of cases. The specificity of the DGP-IgG test is reported to range from 75% to 95%, which means it can correctly identify individuals without the condition in about 75% to 95% of cases.

 

[Russ H]

4 hours ago, Scott Adams said:

The article below has more info about the DGP-IgG blood test for celiac disease. The odds are that the child may have celiac disease, and you may want to consider an endoscopy to confirm this. If the biopsy were negative it could still indicate non-celiac gluten sensitivity, but the child definitely has an abnormal autoimmune response to gluten

 

Isolated DGP IgG as in this case has poor predictive value (only a few percent).

https://onlinelibrary.wiley.com/doi/10.1111/jpc.16071

Based on the results and symptoms, I think it is unlikely to be coeliac disease (although this does not rule it out).

[Victor2022]

5 hours ago, Scott Adams said:

The article below has more info about the DGP-IgG blood test for celiac disease. The odds are that the child may have celiac disease, and you may want to consider an endoscopy to confirm this. If the biopsy were negative it could still indicate non-celiac gluten sensitivity, but the child definitely has an abnormal autoimmune response to gluten:

Here also it says:

The test is not always included in adults, but should be in cases with IgA deficiency. The test should always be included when screening children, especially if they are under 2 years old. The DGP test was created to detect celiac disease in those with IgA deficiency, as it tests for both IgA and IgG antibodies.

Celiac Disease Blood Antibody Screening in Children - Deamidated Gliadin Peptide IgA/IgG Antibody Levels (Also known as DGP tests)

DGP screening should always be done in children, especially in those who are 2 years old or younger. The DGP test is not as sensitive or specific as the tTG-IgA test, but it may be used by healthcare professionals in certain situations. For example, in children under 2 years old, the DGP test may be combined with the tTG-IgA test due to their lower sensitivity. For those with IgA deficiency, the DGP-IgG test may be used.

and also referring to: Celiac Disease Blood Antibody Screening is ~98% Accurate in Adults Using the Mayo Clinic Protocol 

Does it means that this DGP-IGG should have not done? and is not accurately predicting ?  

[Russ H]

7 minutes ago, Victor2022 said:

and also referring to: Celiac Disease Blood Antibody Screening is ~98% Accurate in Adults Using the Mayo Clinic Protocol 

Does it means that this DGP-IGG should have not done? and is not accurately predicting ?  

DGP is part of the standard coeliac blood screening panel. It gives a small increase in predictive value. The fact that the other 2 tests showed very low levels of antibodies combined with a lack of symptoms suggests that this is not coeliac disease.

[Scott Adams]

44 minutes ago, Russ H said:

Isolated DGP IgG as in this case has poor predictive value (only a few percent).

https://onlinelibrary.wiley.com/doi/10.1111/jpc.16071

Based on the results and symptoms, I think it is unlikely to be coeliac disease (although this does not rule it out).

It's a pretty small study, but a positive result, in my opinion, is still indicating gluten sensitivity. It's pretty well known that kids are much harder to diagnose, as their healing abilities are much greater than adults.

I would also add that dozens of other studies show a much higher rate of prediction, and I've never seen a study where DPG scored this badly. If this were actually the case, insurance companies would not pay for this test, and it would not be part of any celiac disease screening protocol.

[trents]

There is the child's unexplained weight loss. It might be a good idea to trial a gluten free diet and see if the weight comes back on. Scott is correct in asserting that the test indicates his immune system is or was on the day of the blood draw reacting abnormally to gluten.

[trents]

Russ, DGP is part of a standard celiac panel if you are using the term panel in the sense of a full panel. I certainly would not say that most physicians order it as a matter of standard practice.

[Russ H]

18 minutes ago, Scott Adams said:

It's a pretty small study, but a positive result, in my opinion, is still indicating gluten sensitivity. It's pretty well known that kids are much harder to diagnose, as their healing abilities are much greater than adults.

I would also add that dozens of other studies show a much higher rate of prediction, and I've never seen a study where DPG scored this badly. If this were actually the case, insurance companies would not pay for this test, and it would not be part of any celiac disease screening protocol.

DGP on its own is fairly good at predicting coeliac disease but it would usually be accompanied by high tTG2. DGP with low tTG2 is not very predictive of coeliac disease.

There is a larger study linked below which indicates a positive predictive value of 2.8% in paediatric patients for isolated DGP.

https://www.sciencedirect.com/science/article/abs/pii/S0009898122011421

[Scott Adams]

Here are some studies I found for the general accuracy of the DGP tests, and some deal with kids as well:

https://pubmed.ncbi.nlm.nih.gov/22266486/ 

https://pubmed.ncbi.nlm.nih.gov/20171961/ 

https://pubmed.ncbi.nlm.nih.gov/17683995/ 

https://pubmed.ncbi.nlm.nih.gov/35903491/ 

https://pubmed.ncbi.nlm.nih.gov/18724250/ 

https://pubmed.ncbi.nlm.nih.gov/22722680/ 

[Russ H]

12 hours ago, Scott Adams said:

Here are some studies I found for the general accuracy of the DGP tests, and some deal with kids as well:

https://pubmed.ncbi.nlm.nih.gov/22266486/ 

https://pubmed.ncbi.nlm.nih.gov/20171961/ 

https://pubmed.ncbi.nlm.nih.gov/17683995/ 

https://pubmed.ncbi.nlm.nih.gov/35903491/ 

https://pubmed.ncbi.nlm.nih.gov/18724250/ 

https://pubmed.ncbi.nlm.nih.gov/22722680/ 

None of those are for isolated IgG DGP. IgG DPG is useful for people who are IgA deficient or for infants under the age of 2, otherwise it has poor predictive value of several percent.

[Victor2022]

1 hour ago, Russ H said:

None of those are for isolated IgG DGP. IgG DPG is useful for people who are IgA deficient or for infants under the age of 2, otherwise it has poor predictive value of several percent.

My till date research also suggest

Deamidated gliadin peptide IgA and IgG antibodies (DGP Abs)

Screening

The preferred screening test in children < 2 years is a combination of TTG IgA and DGP (IgG and IgA)

DGP IgG antibody is useful in patients who have suspected IgA deficiency

Accuracy

Sensitivity (IgG): > 90%

Specificity (IgG): > 90%

Effects of a gluten-free diet

DPG Ab levels (IgG and IgA) will return to normal in patients consuming a gluten-free diet. Weakly positive patients may return to normal within weeks of starting a gluten-free diet. After 6 - 12 months, 80% of patients will have normal levels, and by 5 years, > 90% of patients will be normal. DGP Ab levels may also be used to monitor gluten-free diet compliance.

[Michele2977]

On 5/15/2023 at 1:21 AM, Victor2022 said:

Hi

4 years Child has following blood test results ( only DGP-IGG High)

and has no symptoms like no skin rash, no constipation, no diarrhea, no bloating, no gas, no pain in abdomen, stool is normal and growth is normal. 

TISSUE TRANSGLUTAMINASE AB, IGA 1.6 U/mL (Range <15.0 Antibody not detected & > or = 15.0 Antibody detected)
GLIADIN (DEAMIDATED) AB (IGA) <1.0 U/mL (Range <15.0 Antibody not detected & > or = 15.0 Antibody detected)
GLIADIN (DEAMIDATED) AB (IGG) 18.9 H U/mL (Range <15.0 Antibody not detected & > or = 15.0 Antibody detected)
IMMUNOGLOBULIN A 97 Reference Range: 22-140 mg/dL

Can anyone please interpret it? is it a celiac disease ?

My IgA is negative because I have an IgA deficiency, which means that my body doesn’t produce IgA. I have celiac and was diagnosed by an endoscopy (looking for something else) then had bloodwork done. My IgG was through the roof at first, but my IgA was always negative. Follow up bloodwork confirmed the IgA deficiency, which is an immunodeficiency. Thankfully I have no complications from that at all 

[Victor2022]

2 hours ago, Michele2977 said:

My IgA is negative because I have an IgA deficiency, which means that my body doesn’t produce IgA. I have celiac and was diagnosed by an endoscopy (looking for something else) then had bloodwork done. My IgG was through the roof at first, but my IgA was always negative. Follow up bloodwork confirmed the IgA deficiency, which is an immunodeficiency. Thankfully I have no complications from that at all 

In this case IMMUNOGLOBULIN A or IGA or Total IGA is  with in range. I understand that if total IGA is low then TTG IGA does not hold good and GLIADIN (DEAMIDATED) AB (IGG) or (IGA) comes into picture. Any comment? 

[trents]

2 hours ago, Victor2022 said:

In this case IMMUNOGLOBULIN A or IGA or Total IGA is  with in range. I understand that if total IGA is low then TTG IGA does not hold good and GLIADIN (DEAMIDATED) AB (IGG) or (IGA) comes into picture. Any comment? 

Unfortunately, most physicians never check for deficient total serum IGA. And it's not as though the IGG and DGP tests have no diagnostic value even if total IGA is within normal range.

[Russ H]

10 hours ago, Victor2022 said:

In this case IMMUNOGLOBULIN A or IGA or Total IGA is  with in range. I understand that if total IGA is low then TTG IGA does not hold good and GLIADIN (DEAMIDATED) AB (IGG) or (IGA) comes into picture. Any comment? 

In people who are IgA deficient, IgG tTG2 and/or IgG DGP are merited.