Total Serum Iga?

[veggiemomma]

Does the Total Serum IgA have to be above the normal range in order to be positive for celiac?

I was positive in recent blood work for Endomysial IgA and TTG Serum and told it was highly likely I have celiac. But my Total Serum IgA was in normal range.

I was settling into accepting my diagnosis based off my blood work and was going to skip the biopsy. But last week I went to a GI who said he didn't think I had celiac based off my results.

He recommended gene testing of HLA DQ2 and HLA DQ8. But said even if I have the markers it doesn't mean I have celiac and he would then recommend a biopsy. He repeated that he wasn't convinced I had celiac.

Plus I am not skinny and he said I was not presenting as a typical celiac. He said celiac is a "sexy" diagnosis and he sees people like me all the time that have read up on celiac and come in to the GI thinking they have the disease.

I left his office thinking I was a nut case. But the more I process the more cranky I am becoming. I think a second opinion is in order.

Any thoughts?

[CDFAMILY]

Dear Veggiemomma,

Wow, I am sorry to say this doctor is not very informed about Celiac Disease. He sounds like an old school doctor who keeps rereading his outdated text books.

IgA does not rule in or rule out Celiac Disease. It is only helpful if you are IgA deficient, then, if he knew what he was talking about, he would then know you need to have the TtG IgG test done because the TtG IgA would probably be also low and invalid with the IgA deficiency.

With a positive EMA and TtG your chances of being Celiac are 99% and in my eyes 100%.

What your doctor also does not know because he is not reading the right websites, is that more recently, they are diagnosing more overweight people than underweight people with Celiac Disease. And the symptoms are not the typical ones he learned in med school.

And were he gets the idea that this is a sexy disease...Let's get real....we are talking bloating, gas, ataxia, neuro symptoms, migraines....there is nothing and let me repeat myself, Nothing sexy about any of this.

This was published in Pubmed:

Open Original Shared Link

1: Aliment Pharmacol Ther. 2008 Apr 1;27(7):572-7. Epub 2008 Jan 11.

Coeliac disease: a biopsy is not always necessary for diagnosis.

Hill PG, Holmes GK.

Department of Chemical Pathology, Derbyshire Royal Infirmary, Derby, UK.

BACKGROUND: In view of the high diagnostic accuracy of immunoglobulin-A-tissue transglutaminase antibodies for detecting coeliac disease, we have explored whether a small bowel biopsy is always required to establish the diagnosis. AIM: To define the transglutaminase antibody level giving a positive predictive value for coeliac disease of 100% and to subsequently assess the proportion of new diagnoses of coeliac disease having such a result. METHODS: The Celikey kit (Phadia GmbH, Frieburg, Germany) was used to measure transglutaminase antibody levels. RESULTS: All patients with transglutaminase antibody levels >30 U/mL, i.e. 10 x upper limit of normal in 2002/2003 had characteristic small bowel mucosal lesions. In a subsequent audit, 58% of 112 new diagnoses of coeliac disease in 2004/2005 had levels above this cut-off value. CONCLUSIONS: We have shown that a transglutaminase antibody level can be defined which gives a positive predictive value of 100% for coeliac disease. From published data, these observations can be extended to most second-generation transglutaminase antibody kits. Our data provide further evidence that diagnostic guidelines could be modified so that small bowel biopsy is no longer regarded as mandatory in patients with such high transglutaminase antibody levels. This will avoid an invasive procedure and lead to a more rapid diagnosis and earlier treatment for over half of the new patients with coeliac disease.

PMID: 18194500 [PubMed - indexed for MEDLINE]

You might want to make a copy of this and take it to the doctor. But, I will add that many Gastro's will still insist on a Biopsy to give a gold star Celiac dx but anymore many people do not care about the biopsy.

I am not sure I would even trust this doctor to do a biopsy because they need to be done a specific way and need several biopsies.

Good Luck

[happygirl]

Definitely find a new doctor!

[psawyer]

Total serum IgA must be tested in order for the other results to be valid. If it is not normal, then the other test results are cast into doubt. If the total serum IgA is below normal, then the other tests may yield a false negative, because your system is suppressed and is not producing antibodies to anything--gluten would be no exception. If the total serum IgA is above the normal range, then it *might* indicate that the gluten tests could show exaggerated levels.

[CDFAMILY]

Thanks Peter,

I was hoping someone would explain the IgA deficiency a little better.

[ravenwoodglass]

Dear Veggiemomma,

Wow, I am sorry to say this doctor is not very informed about Celiac Disease. He sounds like an old school doctor who keeps rereading his outdated text books.

IgA does not rule in or rule out Celiac Disease. It is only helpful if you are IgA deficient, then, if he knew what he was talking about, he would then know you need to have the TtG IgG test done because the TtG IgA would probably be also low and invalid with the IgA deficiency.

With a positive EMA and TtG your chances of being Celiac are 99% and in my eyes 100%.

What your doctor also does not know because he is not reading the right websites, is that more recently, they are diagnosing more overweight people than underweight people with Celiac Disease. And the symptoms are not the typical ones he learned in med school.

And were he gets the idea that this is a sexy disease...Let's get real....we are talking bloating, gas, ataxia, neuro symptoms, migraines....there is nothing and let me repeat myself, Nothing sexy about any of this.

This was published in Pubmed:

You might want to make a copy of this and take it to the doctor. But, I will add that many Gastro's will still insist on a Biopsy to give a gold star Celiac dx but anymore many people do not care about the biopsy.

I am not sure I would even trust this doctor to do a biopsy because they need to be done a specific way and need several biopsies.

Good Luck

Thanks for giving us the link to that article. It will be helpful for many.

[EmmaFrost]

Does the Total Serum IgA have to be above the normal range in order to be positive for celiac?

I was positive in recent blood work for Endomysial IgA and TTG Serum and told it was highly likely I have celiac. But my Total Serum IgA was in normal range.

I was settling into accepting my diagnosis based off my blood work and was going to skip the biopsy. But last week I went to a GI who said he didn't think I had celiac based off my results.

He recommended gene testing of HLA DQ2 and HLA DQ8. But said even if I have the markers it doesn't mean I have celiac and he would then recommend a biopsy. He repeated that he wasn't convinced I had celiac.

Plus I am not skinny and he said I was not presenting as a typical celiac. He said celiac is a "sexy" diagnosis and he sees people like me all the time that have read up on celiac and come in to the GI thinking they have the disease.

I left his office thinking I was a nut case. But the more I process the more cranky I am becoming. I think a second opinion is in order.

Any thoughts?

I am sorry you are having trouble finding a competent Dr. that is more knowledgable about Celiac Disease. His comment is negligent since someone could come into see him, someone who is depending on his expertise and be naive enough to think that Celiac is a "sexy" disease. That's absurd.

I am almost in the same boat and I've been to three Dr.'s, one that ran one Celiac Blood Test which indicated I was negative, but my IGA Serum was low and this Dr. told me that a low IGA serum had no impact on the Celiac Blood Test. I asked him why it was run in the first place then and why did Quest put a asterix next to my abnormal value if it had no meaning. Silent pause, then he said it's just part of the Celiac panel. My family Dr. whom I really like followed up based on my concerns, but ran the older test, for antigladin and once again I had low IGA (not zero) and they did not tell me I had to be eating gluten for the test after I asked. My Dr. and the nurse drawing the blood said it didn't matter if I was not eating gluten. I went on a trial diet to see if I would feel better. In any event I then went to a GI I was referred to who is suppose to be highly regarded and he immediately said the only way to diagnose Celiacs Diseaase is through a biopsy and said I would have to eat wheat again for 4 weeks. I was thinking initially it sounded like he would be a good Dr. until I told him about the rash I've been getting for almost 8 years and that it looked just like DH. I asked him if it would be possible to do a biopsy on the rash rather then an invasive intestinal biospy requiring anesthsia and he said he didn't know anything about it and I would have to go see a dermatologist if I was having skin issues. I give up, at least for today : )

[ddennis11]

Total serum IgA must be tested in order for the other results to be valid. If it is not normal, then the other test results are cast into doubt. If the total serum IgA is below normal, then the other tests may yield a false negative, because your system is suppressed and is not producing antibodies to anything--gluten would be no exception. If the total serum IgA is above the normal range, then it *might* indicate that the gluten tests could show exaggerated levels.

New to this site and you might have the answers to the my questions. Sorry to take it off topic somewhat ... My 12 year daughter, btw dyslexic and ADD, has had a range of symptoms over the years. Elementary school years digestive then gluten free for almost 3 years (high gladin antibodies and low Immungolobin A 58 -- allergist wanted her to go gluten-free). GI at time laughed me out of his office for suggesting celiac. Pressure from hubby to try gluten again. back on gluten for several years with seemingly no issues. fast forward to present -- troubles sleeping, tired all the time, occasional stomach issues. Back to allergist for blood work and now her Immunoglobin A is low, 29, and gladin antibodies are high, 56 -- other testing, Ttg. negative. Gene test shows one gene for celiac. I have several questions for you if you could help 1) is the low Immunoglobin A really low enough to effect the testing -- allergist says yes -- GI we saw on Friday says not low enough. 2) will it get better with a gluten free diet? -- worried about future auto immune issues 3) does the Absolute Eosinophils of 2784 have any significant (read up on it but no one seems to think it significant)? Husband and his family long list of autoimmune MS, IBS, Acid Reflux, fibromyalgia, psoriasic arthritis between the 3 of them. My larger question is to have her scoped (GI will do it if we want) or just go gluten free and see (as her ped. doc. says)

Any insight would be wonderful!!

[Skylark]

Has she been given the IgG version of the celiac panel? Low IgA is a risk factor for celiac. She needs IgG anti-TTG and ask your doctor about the new anti-deamidated gliadin peptide IgG. It's more sensitive and very specific.

The gluten-free diet does not effect low IgA, but she will be fine.

She may need a firm diagnosis for school, so either the scope or better blood tests will get that. Also, a positive scope will leave no questions for her later in life when she is inclined to challenge things like a restrictive diet. One important question for kids is whether her doctors are willing to diagnose her as celiac for school. She may need the diagnosis at some point to get school lunches, or gluten-free food in college.

[ddennis11]

Has she been given the IgG version of the celiac panel? Low IgA is a risk factor for celiac. She needs IgG anti-TTG and ask your doctor about the new anti-deamidated gliadin peptide IgG. It's more sensitive and very specific.

The gluten-free diet does not effect low IgA, but she will be fine.

She may need a firm diagnosis for school, so either the scope or better blood tests will get that. Also, a positive scope will leave no questions for her later in life when she is inclined to challenge things like a restrictive diet. One important question for kids is whether her doctors are willing to diagnose her as celiac for school. She may need the diagnosis at some point to get school lunches, or gluten-free food in college.

Not sure still confused about all the testing and which are which ... but she has had the

Tissue Transblutamiinsae (IGG) TTG antibody , IGG which was negative and

Tissue Transglutaminnase Antibody IGA TTG antibody IGA which was negative.

Do not think that she has had the anti-deamidated glaiadin peptide IgG testings. Will ask GI for the testing.

Just got her genetic testing results and she is positive for HLA-DQ2 (DQA1*05/DQB1*02) which from my reading is very common in celica (but also in the population at large also)

HLA-DQ8 (DQA1*03/DQB1*0302)

HLA-DQA1 * 05

HLA-DQA1 * -

HLA-DQB1 * 0201

HLA-DQB1 * 0301

I am thinking to do the scope so that we don't fall back into the gluten trap. Her dad is a softy and will not want to deny her and "a little can't hurt" will be his phrase. But hate to make her do if I am just being an over-acting mother. So confused.

[Skylark]

She actually has 2 genes that are common in celiac, DQ2.5 and DQ8. Deamidated gliadin peptide and the scope sound like a good idea. That way you'll know for sure whether or not her dad can give her a cookie once in a while. If I had those genes (don't know what mine are) I would go "gluten-light" at a minimum to keep problems from cropping up in the future.

[ddennis11]

She actually has 2 genes that are common in celiac, DQ2.5 and DQ8. Deamidated gliadin peptide and the scope sound like a good idea. That way you'll know for sure whether or not her dad can give her a cookie once in a while. If I had those genes (don't know what mine are) I would go "gluten-light" at a minimum to keep problems from cropping up in the future.

Thank you for your info. She did have a negative for the DQ8 I did not type that part in -- thought I did. Do you know what the later four lines mean? Thank you!!!

[Skylark]

Thank you for your info. She did have a negative for the DQ8 I did not type that part in -- thought I did. Do you know what the later four lines mean? Thank you!!!

Oh - I was confused reading that too. The DQB1*0301 has the older name of DQ7. It's not a "celiac" gene, but it looks like she maybe has two copies of DQA1*05 since they don't list anything else. If so, she makes more DQ2.5 than someone with a different DQA1 would (DQ2.5 is one DQB*0201 and one DQA*05), but not as much as someone who is double DQ2.5. It means she is somewhat more prone to celiac than someone with DQ2.5 and a completely different A and B.

[ddennis11]

Oh - I was confused reading that too. The DQB1*0301 has the older name of DQ7. It's not a "celiac" gene, but it looks like she maybe has two copies of DQA1*05 since they don't list anything else. If so, she makes more DQ2.5 than someone with a different DQA1 would (DQ2.5 is one DQB*0201 and one DQA*05), but not as much as someone who is double DQ2.5. It means she is somewhat more prone to celiac than someone with DQ2.5 and a completely different A and B.

Thanks!! I have been reading/researching and the DQB1*0301 has something the best I can tell with Melanoma (along with other things). I had a melanoma removed last December. Guess I know where she got that from! I was wondering too why they -'ed the second DQA1 but it makes sense that it would be a second copy. Thanks for your help. This is very confusing and even when you think you got it -- I lose it!!