Ttg, Ema, Aga, Iga, Igg

[Amica]

I was diagnosed with a gluten sennsitivity in 2004. My Doc said I did not have celiac disease because my endoscopy results were negative (after a few weeks eating gluten-free). Since then I have been comfortably eating a "low gluten" diet.

After hearing more and more about the health problems associated with untreated celiac disease, I have been doing some research online. Since my diet is not entirely gluten free, I want to make sure I don't have celiac. I am considering going back to my doctor soon, and asking for a full celiac panel.

I had my first (and only) blood screening for celiac in 2003. My Doctor ordered tests for anti-gliadin (AGA) antibodies. My results were as follows:

Anti-gliadin (IgG): 50 (with greater than 30 indicating a moderate to strong positive)

Anti-gliadin (IgA): 10 (with less than 20 indicating a negative)

However, today I was reading about the meaning of each test on labtestsonline.org and found that "AGA IgG and IgA are often ordered together so that their results can be compared. If one is positive, both should be - unless the patient has an IgA deficiency." I started looking into IgA deficiency, and it is a pretty serious auto-immune disease that I don't really show any symptoms of. (I work with kids and do get occasional colds, but have never considered myself to have a weak immune system.) Is there anyone out there with IgA deficiency?

Also, is any antibody test-- AGA, EMA, ARA, or tTg-- anymore reliable than the other? Should I ask my doctor for all of these tests? If I do have the tests, should I "gluten-up" for them? I haven't been completely gluten free in over a year, but do limit it in my diet.

Please share advice!

[tarnalberry]

Many celiacs have IgA deficiency, and it's not always horridly serious. Without a total IgA test, your IgA value doesn't tell you anything, and is worth checking on. Your test results seem, at the least, inconclusive. If eating gluten-free makes you feel better, that's important confirmation.

[Rachel--24]

Hi Amica,

I will try to answer some of these questions as best I can.

However, today I was reading about the meaning of each test on labtestsonline.org and found that "AGA IgG and IgA are often ordered together so that their results can be compared. If one is positive, both should be - unless the patient has an IgA deficiency."

This isnt entirely true. Many times people come back with positive IgG only and they are not IgA deficient. Some people have elevated IgG and are not Celiac.....but reacting to gluten nonetheless.

Sometimes they are both positive..and sometimes only one is positive. Some people may have negative IgG and positive IgA. There is no perfect set of rules when it comes to the immune system.

I started looking into IgA deficiency, and it is a pretty serious auto-immune disease that I don't really show any symptoms of. (I work with kids and do get occasional colds, but have never considered myself to have a weak immune system.) Is there anyone out there with IgA deficiency?

There are people here with IgA deficiency. It means that their immune system doesnt produce enough IgA antibodies to test positive in the testing. This is why the Celiac Panel has a "total serum IgA" test...to make sure there is not a false negative.

As far as I know this isnt a serious auto-immune disease....but it can cause the Celiac results to be false negative. In my case the Dr.'s have told me that my immune system doesnt produce enough IgG....my IgG production is less than whats considered normal.

Also, is any antibody test-- AGA, EMA, ARA, or tTg-- anymore reliable than the other? Should I ask my doctor for all of these tests? If I do have the tests, should I "gluten-up" for them? I haven't been completely gluten free in over a year, but do limit it in my diet.

The tTg test is the most specific for Celiac....EMA is also specific but I think they use tTg more often these days.

Yes....you would need to be eating plenty of gluten for a few months prior to testing. If you go into testing now (having been low-gluten) you may not get accurrate results.

Also if you load up on gluten and are experiencing symptoms...you should be gluten-free regardless of the test results. The most reliable test is your own bodies response to gluten and to the gluten-free diet. You can have gluten intolerance and not have Celiac Disease.

The elevated IgG in your results shows that your body is reacting to gluten in a negative way.

Good luck.

[jayhawkmom]

However, today I was reading about the meaning of each test on labtestsonline.org and found that "AGA IgG and IgA are often ordered together so that their results can be compared. If one is positive, both should be - unless the patient has an IgA deficiency."

I'm not IgA deficient and I have a very high positive to IgG AB's - without IgA AB's (high normal). Same with my daughter.

IgG is less specific to Celiac/gluten intolerance - but it's a more sensitive test... while IgA is less sensitive, but more specific to Celiac/gluten sensitivity, which is why they are ordered together.

tTg is specific ONLY to Celiac - and I'm not positive about EMAB's.

All of the parts of the panel together give a clearer picture... often clear as mud. LOL!!

I know that the antibody tests are used to monitor compliance with a gluten-free diet, obviously....the longer one is gluten free, the lower the antibodies present in the blood.

My IgG levels went down drastically in two weeks on a gluten-free diet. IgA levels remained the same, but they were normal to begin with. Went from 69 (with a reference range of less than 11 as normal) down to 47.

I realize I'm not helping you any here....but, I don't think that it's an accurate statement that they are either both positive, or both negative, unless IgA deficient.

I'm sure there will be wiser people with more experience that can help you. I'm going to try to find the post that I added the other day about the specifics of IgA and IgG antibodies.

[Amica]

Thanks for the help everyone! I am going to call to make an appointment with my Doctor tomorrow. I'm glad to go in knowing what tests to ask for!

[chrissy]

i have a son that is IgA deficient and we didn't even know it until he was first screened for celiac-----so it is not necessarily a serious problem, although it does explain the numerous ear infections he had and the fact that he seems to have a mild cold most of the winter.(i thought he had allergies)