Immunoglobulins test result

[Roseirish]

My 9. Year old daughter just recieved her blood results for immunoglobins. 
weight 35.8

IgA 2.97 g/l.   0.70-2.50g/l

IgG. 14.47.      5.4-16.10g/l

IgM.  0.37.       0.50- 1.80g/l

 

My daughter’s symptoms have been very bad stomach pains and severe headaches - she would go very pale.    Have been waiting on these test results for a while this is the third time bloods have been taken as labelled wrong.     I have went gluten and milk free and discussed it with her gp as she was in so much pain as said she can’t go on like this waiting for these results .    Most days she is composing of stomach pains still I am at a lost as to what could be causing this .    Any help would be appreciated. Thanks 
 

 

[Roseirish]

Realised spelling mistake should be most days complaining - sorry 

[trents]

Unfortunately, if she was already eating gluten free when these blood tests were taken the results would not be accurate unless it was within days (as opposed to weeks) of beginning the gluten-free diet. However, the IGA is a little elevated. Is that tTG-IGA or is it total IGA? If it is tTG-IGA it would suggest celiac disease. We need more specific information on the type of IGA test it was. At her young age, there are other celiac marker tests that should have been run as children often don't respond the same way to the the tTG-IGA tests as adults do. There immunes systems are not yet mature.

Edited April 8, 2024 by trents

[Roseirish]

I haven’t spoke to the doctor yet re these results.  Ringing me tomorrow evening.   What test do you suggest I should get carried out?  Her stomach is very sore and although I have been carrying out a gluten and dairy free diet due to her intolerance as a baby to milk protein she is still complaining or a sore stomach but not as sore as when eating gluten constantly .      

[trents]

How long have you had her on a gluten free diet?

Believe me, I understand that you do not want to torture your daughter by keeping her on gluten but testing is a waste of time if she has been on a gluten free diet for any length of time. The blood tests are checking for antibodies produced by the inflammatory reaction to gluten in the gut experienced by those with celiac disease. It takes weeks/months for these antibodies to build up to test detectable levels. Once you remove gluten from the diet the inflammation begins to subside and the antibody levels begin to drop. 

Once gluten has been removed from the diet for a period of weeks, it must be reintroduced for a period of weeks in order for antibody levels to rebuild. And we're talking about the daily consumption of an amount of gluten equivalent to about 4-6 pieces of bread made with wheat flour for at least two weeks and longer would be better. We call this a "gluten challenge."

If your doctor says that the testing is negative or inconclusive for celiac disease then you have a choice to make. If you really want a firm diagnosis you will need to start the gluten challenge. If you decide you cannot go through with the gluten challenge then you will need to be willing to live with the uncertainty of not knowing whether or not she has celiac disease.

If you are convinced that gluten is causing her issues but the testing does not confirm celiac disease, it is also quite likely she has NCGS (Non Celiac Gluten Sensitivity) for which there is no testing at this point in time but which is 10x more common than celiac disease and shares many of the same symptoms. However, NCGS does not cause damage to the villous lining of the small bowel as does celiac disease. Having said that, some experts believe NCGS can be a precursor to celiac disease. At the end of the day, however, both require total abstinence from gluten.

If you decide to do the gluten challenge, you should ask for these four tests to be run at the end of the challenge period: total IGA, tTG-IGA, DGP-IGA and DGP-IGG.

Finally, it is very common for those with celiac disease or NCGS to also be dairy intolerant, either to the lactose in dairy or the protein, casein. Casein, like gluten, can cause elevated antibody levels in some celiacs. Their protein structures are very similar.

 

[Scott Adams]

It would be good to get more info about those tests, as the way they are written it is hard to know for sure exactly what tests were done. If the first test was a tTg-IgA that was positive for celiac disease, then the next step would likely be an endoscopy to confirm it. It her symptoms have improved on a gluten-free diet you may wish to pass on the endoscopy, but then your doctor may not be able to make an official diagnosis. To do the biopsy she would need to be eating gluten daily before the test, per below.

Here is more info about how to do a gluten challenge for a celiac disease blood panel, or for an endoscopy:

Quote

"...in order to properly diagnose celiac disease based on serology and duodenal histology, doctors need patients to be on gluten-containing diets, even if they are causing symptoms, and this is called a "gluten challenge."

• Eat gluten prior to celiac disease blood tests: The amount and length of time can vary, but is somewhere between 2 slices of wheat bread daily for 6-8 weeks and 1/2 slice of wheat bread or 1 wheat cracker for 12 weeks 12 weeks;
• Eat gluten prior to the endoscopic biopsy procedure: 2 slices of wheat bread daily for at least 2 weeks;

and this recent study recommends 4-6 slices of wheat bread per day: