Confused lab results

[Mlsilva]

My daughters lab results 

Transglutaminase IgAValue

<1.0

Value Interpretation

<15.0 Antibody not detected

> or = 15.0 Antibody detected

IgA 73

No serological evidence for celiac disease is present. tTg may normalize in individuals with celiac disease who maintain a gluten free diet. If high suspicion of celiac disease, consider HLA DQ2 and DQ8 testing to rule out celiac disease

[trents]

Welcome to the forum, @Mlsilva!

By any chance, had your daughter already started the gluten free diet before the celiac blood antibody testing was done or was she cutting back on wheat-based foods?

What is normal range for IgA used by the lab who did the analysis? Your daughter's score on that, what we call "total IGA" is 73 but you did not give a range for what is normal. If total IGA is low, it can cause false negatives in individual IGA tests. Total IGA is not in and of itself a diagnostic test for celiac disease but a low total IGA value can skew the ones that are.

How old is your daughter? The one test that was run on her for celiac disease per se was the tTG-IgA for which she scored under 1. That is them most common single test that physicians run when testing for celiac disease but it is not as reliable for children as it is for adults because children have immature immune systems.

[Mlsilva]

We've cut back a bit but not really she still has whole wheat bread with lunch and previous of this blood work she had a wake up wrap from dunkin. The normal range is 31-180. She is 7 years old.

[trents]

At 7 years old I would not trust the results of the tTG-IGA test alone.

The one shot of Dunkin Wakeup Wrap before the blood draw for antibody testing would have no impact on results. Perhaps explaining what the antibody testing is measuring would help you understand all this better.

For a person with celiac disease, the consumption of gluten triggers an autoimmune response in the lining of the small bowel. The immune system mistakenly interprets gluten as an invader and marshals defenders called antibodies to the attack area . These antibodies fight against the gluten invader and this causes inflammation in the lining of the small bowel every time gluten is consumed. Over time (months to years) this damages the lining of the small bowel and eventually results in vitamin and mineral deficiency related health problems since this area of the intestinal track is where all of our nutrition is absorbed. Celiac antibody testing measures the levels of certain antibodies connected with celiac disease. It takes time (weeks to months) for these antibodies to build up to measurable levels. So eating a gluten heavy meal immediately before testing will have no real impact on antibody levels. However, eating generous daily amounts of gluten weeks or months ahead of the testing will get antibody levels up to measurable amounts. So, for antibody test results to be reliable, your daughter would need to be eating the gluten equivalent of about 4 slices of bread (white or whole wheat, makes no difference) daily for three weeks leading up to the day of testing. And the gluten can be consumed through pasta or any wheat product, not just loaf bread. The four slices is just an amount guideline. We call this a "gluten challenge."

The other thing, as I have already mentioned, is the questionable reliability of the tTG-IGA test on children her age. There are other tests that should be run at her age that often catch celiac disease in children that the tTG-IGA misses. 

So, here is what I would recommend:

1. Undertake a rigorous gluten challenge as outlined above. There is a question in my mind as to whether she was consuming enough gluten during the weeks/months leading up to her original testing blood draw in order to produce reliable results.

2. Get her retested for celiac antibodies. Ask for the following tests: Total IGA, tTG-IGA, DGP-IGA and DGP-IGG. The last two are ones you haven't had run yet.

 

Here is a primer for understanding celiac disease antibody testing: 

Genetic testing for HLA DQ2 and HLA DQ2 is a good idea to establish whether or not your daughter has the potential to develop celiac disease. It cannot be used to diagnose for celiac disease since 40% of the population carry one or both of these genes.

There is also the possibility she has NCGS (Non Celiac Gluten Sensitivity) which shares many of the same symptoms with celiac disease but for which there is no test. Celiac disease must first be ruled out. NCGS is 10x mor common than celiac disease. Some experts believe NCGS can be a precursor to celiac disease.