Low Iga Serum Level In Child

[pumpkin65]

Hello all,

First post...mom of 14 yr old daughter with a variety of auto immune issues, trying to learn if she might have celiac's.

She has had cough variant asthma, which seems to have resolved in the past 3 years. She is hypothyroid, and on synthroid (not yet diagnosed at this point with auto immune thyroid disorder, such as Hashimotos). She has had alopecia (hair loss) twice - we thought this was BECAUSE of her thyroid problem. She has had SEVERE constipation in the past (again, we thought because of thyroid), periodic diarrhea, and vomits more than our other daughter. The severe constipation has gone away since the thyroid meds. The alopecia has recently returned. She has pretty severe scalp psoriasis, and occasional spots on her body - either eczema or psoriasis. She had spots on her bottom last week. When she was younger, she had pigment 'dropping out' on her legs. I don't see that any more. She sometimes describes having what I believe is neuropathy - shooting pains in her feet. She has ADD, and takes concerta which has worked well.

She has had slowish growth, adult teeth are late to come in, puberty is happening but slowly.

Anyway, I was looking at some 3 year old bloodwork (I don't have recent bloodwork handy) and I see she has a low serum IGA? It says 12 mg/DL. On the same report, it says her gliadin AB is <3 U/ml. Tissue transglutaminase as IGA <3 U/ml and tissue transglutaminase as IGG <3.

What does a serum IGA in this range really mean, in light of the other readings, which I guess are normal?

I will update in a few days with the genetic tests.

We are in the process of getting genetic results back from Prometheus. Should have in a few days (this is for DQA2 and DQA8 - I guess???)

[mushroom]

Hi, and welcome to the forum.

Your daughter does present with a variety of auto immune issues that could be related to celiac disease - alopecia, psoriasis, hypothyroidism, neuropathy. The low serum IGA is significant - see the following:

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"The celiac blood test panel includes the total serum IgA test because some people are IgA-deficient. If you have a very low total serum IgA, that can invalidate the three blood tests that rely on your IgA levels. People with celiac disease suffer from low total IgA levels about 10 to 15 times more frequently than people in the general population."

Do you have any idea what recent blood work she has had done and has it included testing for celiac disease specifically? There are a couple of other tests that can be done for celiac disease and should be done for someone who is serum IGA deficient: endomysial antibodies, and deamidated gliadin peptide. Her genetic test results will be interesting although not necessarily that informative as they merely indicate whether she could potentially develop a gluten intolerance. not whether she actually has it. Also, they normally only test for a couple of the genes.

Keep us informed of her progress in diagnosis.

[pumpkin65]

All recent bloodwork is specific to monitoring her thyroid only.

If the genetic test comes back as "positive", I guess we truly need to do some more blood work, and maybe biopsy? or more bloodwork regardless of the genetic test?

It looks to me like they tested for the other IG stuff 3 years ago, but it looks 'normal' - but it seems I see others saying these can be falsely negative?

[mushroom]

If it were my daughter I would ask for the two blood tests I mentioned, and for the endoscopy with biopsy. A lot can change in three years. But even if everything comes up negative, as you have learned there is a 20% false negative rate on both blood and biopsy, and the only real, for sure test is whether or not she responds to the diet. I would give it a three-month trial regardless of the outcome of any testing.

[pumpkin65]

checking back in...her genetic test results came back today...I might post another thread to see if anyone can decipher this, in context with her other symptoms.

It said she has DQ2.5 (HLA DQA1*05:DQB1*0201) and other

non-risk alleles.

will the endomysial antibodies, and deamidated gliadin peptide test be accurate if she has been gluten free for around 5 weeks?

Because she really hasn't had too many 'gut' symptoms, I am not sure if a biopsy would tell anything. And her gut symptoms could be explained by random illness.

[Skylark]

Your daughter has two celiac risk factors, the low IgA and the copy of DQ2.5. Fortunately she didn't get two genes that are associated with celiac. I wouldn't feel completely confident about testing after five weeks gluten-free. The three year old tests are exactly that - three years old. They are not a guarantee that she hasn't developed antibodies since. How is she responding to the diet?

Also, you and your husband might want to to be tested for celiac. One of you has DQ2.5 as well.

[pumpkin65]

I figured one of us would have to have given her the DQ 2.5. But many people have DQ 2.5, correct? Neither he or I have symptoms...I've always had a slightly irritable stomach - but that's it.

It's hard to say how she is doing on the diet, since her gut problems were very sporadic and not terrible. One of her bald spots is filling in, and no new spots have shown up. Her psoriasis looks the same. She has not complained of neuropathy. She is not irritable - and she can be at times. She did have diarrhea one day - don't know why. She is being very positive about the diet and adjusted easily.

We did not go down the gluten free path because of GI issues - I got a suspicion she was malabsorbing nutrients because of her delayed growth, hair issues, skin issues - so started researching and learned many of her auto immune issues are shared with folks who have celiacs. I was surprised at the 'clustering' of illnesses and the similarity with others.

I also became suspicious because my just aunt died after an illness that seems eerily like undiagnosed celiacs. As we put all the facts together, I can't help but think it was.

Thank you for your help.

[Skylark]

It's a shame the psoriasis has not improved yet. I think you're right to stick to the diet given all her other autoimmunity and delayed growth. I really hope more of her symptoms improve with longer on the diet. Five weeks is a relatively short time and the positive signs you are seeing must be encouraging.

I would urge you and your husband to get a celiac blood panel if your insurance covers it. Celiac can be silent but still put you at risk for Hashimoto's and troublesome osteoporosis later in life. The single biggest risk is a first-degree celiac relative and it's estimated to be 1 in 20.

[nora-n]

DQ2,5 is the most common gene found with celiacs, but many non-celiacs have DQ2 too.

I would really suspect celiac with these genes and symptoms.

The celiac tests are not so accurate after five weeks off gluten, but could still be positive now.

alopecia is autoimmune, thyroid is, and the exzema probably too.

gluten is known to trigger antibodies.

[pumpkin65]

thanks...I just wonder if she is IGA deficient if a blood test would ever be right?if you are IGA deficient at age 11, are you always IGA deficient, or does that change?

Her other IG readings were <3mg...I wonder if that means they were deficient also. ???? She will have new bloodwork in the coming weeks, so we will see what is up.

Who knows...the hair loss could be because her thyroid meds are off.

She is devoted to the diet - I have to give her a lot of credit. I am impressed with her label reading skills.