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Scott Adams posted an article in Oats and Celiac Disease: Are They Gluten-Free?Thompson T. NEJM. 2004;351:2021-2022 (Nov. 4, 2004, Number 19) Celiac.com 11/09/2004 - While oats do not appear to naturally contain gluten, like other grains they can become contaminated during harvesting, transporting, milling and processing. Many studies have shown that moderate amounts of uncontaminated oats are safe for most adults with celiac disease. There may, however, also exist a sub-set of celiacs who also have avenin-reactive mucosal T-cells, avenin being the oat counterpart to wheats gliadin. To summarize the study—12 containers of oats representing 4 different lots of 3 brands (Quaker, Country Choice, and McCanns) were tested for gluten contamination using the R5 ELISA developed by Mendez. Contamination levels ranged from below the limit of detection (3 ppm gluten) to 1807 ppm gluten. Three of the 12 oat samples contained gluten levels of less than 20 ppm, and the other nine had levels that ranged from 23 to 1,807 ppm. All brands of oats tested had at least 1 container of oats that tested above 200 ppm gluten. It is interesting to note that Country Choice oats ranged from below the limit of detection to 210 ppm—an amount that is nearly at the level allowed by the Codex Alimentarius for products that normally contain gluten but have had their gluten removed—and of the three brands had the least amount of cross-contamination. We must caution, however, that the sampling done in the study was much to small to make any firm conclusions about the average level of gluten-contamination of each of these brands. This study shows that cross-contamination is indeed a concern for celiacs who want to try oats. Celiac patients should contact oat millers directly and talk to them about their clean-out procedures, and whether they have done any testing of their own for gluten cross-contamination.
Scott Adams posted an article in Celiac Disease Diagnosis, Testing & TreatmentAm J Gastroenterol. 2006;101(7):1597-1600. Celiac.com 08/14/2006 – In an effort to increase the diagnosis rate of celiac disease, researchers in Italy conducted a study to determine the accuracy of two of the new "at home" type rapid commercial celiac disease test kits--both of which require only one drop of whole blood to gain results. Both of the kits detect IgA-IgG anti-human-transglutaminase antibodies (anti-h-tTG) in serum and IgA anti-h-tTG antibody in a single drop of whole blood. The researchers analyzed the serum samples of 114 biopsy-confirmed celiacs, 120 healthy controls, 20 first-degree relatives of celiacs, and 75 diseased controls, and compared them to the standard enzyme-linked immunosorbent assay testing method. Whole blood samples were taken in 51 of the biopsy-confirmed celiacs and 100 controls. The serum-based test was found to be positive in all 114 celiac patients, or 100% sensitivity, and among the controls which included three with celiac disease there was 94.9% sensitivity. The accuracy of the blood drop-based assay testing was positive in 46 of the 51 celiacs tested, which equals 90.2% sensitivity. The accuracy, however, is actually higher because five of the patients who tested negative had total IgA deficiency, so the real sensitivity level is actually 95.8%. All 100 controls tested negative which equals 100% specificity. Given the high degree of accuracy of the two commercial test kits that were evaluated the researchers conclude that general practitioners should utilize these low cost kits during standard office visits whenever celiac disease is suspected.
Jefferson Adams posted an article in Celiac Disease Diagnosis, Testing & TreatmentCeliac.com 03/12/2009 - The latest antihuman tissue transglutaminase (tTG) IgA tests are reported to spot celiac disease with nearly 100% sensitivity and specificity. Also, a new generation of deamidated gliadin peptide (Î±-DGP) antibody tests is alleged to have sensitivity levels on par with the tTG IgA tests. However, in actual practice, sensitivity and specificity for these tests are often lower than claimed for trial conditions. A team of Columbia University researchers recently evaluated sensitivities and specificities of four commercial IgA tTG kits, along with three commercial deamidated gliadin peptide (Î±-DGP) kits. The team evaluated the results for four tTG IgA assays: A—Inova (Hu red blood cell); B—Binding site (rHu Ag); C—Eurospital (rHu Ag), D—Immco (rHu Ag) and three Inova Î±-DGP assays, E—Î±-DGP-IgA, F—Î±-DGP-IgG, and G—Î±-DGP-IgA+G. The research team was made up of Afzal J. Naiyer, MD; Lincoln Hernandez, MD; Edward J. Ciaccio, PhD; Konstantinos Papadakis, MD; John S. Manavalan, MD; Govind Bhagat, MD; Peter H. R. Green, MD, all associated with the Department of Medicine and Pathology, Columbia University, New York, NY. The team used blood samples from four different groups of celiac disease patients and controls: Group 1 consisting of 28 patients with active celiac disease; Group 2 consisting of 54 celiac patients following a gluten-free diet; Group 3 consisting of 40 healthy controls; Group 4 consisting of 57 disease controls—17 with Crohn's disease, and 40 with chronic hepatitis. In each case, the researchers used the manufacturer's own cut-off values. They found that sensitivities and specificities of different kits ranged from 71.4% to 96.4% and 87.5% to 100%, respectively. Compared with disease controls, sensitivity for Group 1 stayed the same, while specificity fell. All tests showed higher sensitivities for higher patient villous atrophy. The study showed that overall sensitivity was 90% or less, which is below figures reported in the literature. Recombinant and red blood cell antigen-based tTG assays performed similarly, while the Î±-DGP tests showed lower values. The bottom line was that a number of factors can influence the sensitivity and specificity for these test, and that doctors should keep these facts in mind when evaluating patients. Journal of Clinical Gastroenterology: Volume 43 (3) March 2009, pp 225-232
Celiac.com 12/12/2004 - A new study that was presented on November 1, 2004 by Julian Abrams, MD, and colleagues from Columbia University Medical Center in New York City at the American College of Gastroenterology (ACG) 69th Annual Scientific Meeting indicates that using only antibody to tissue transglutaminase (tTG) to diagnose celiac disease will likely result in missed diagnoses—and the accuracy of the tTG results depends on which lab conducts the test. Many clinical studies during the past few years have indicated that tTG testing is as accurate as endomyosial antibody (EMA), which has caused many labs to use tTG rather than EMA, and even the recent National Institutes of Health Consensus Conference on Celiac Disease advocated the use of tTG over EMA. In the study the researchers evaluated the effectiveness of tTG in a general referral practice medical setting by reviewing 137 patients who had duodenal biopsy and tTG testing for celiac disease, out of which 117 were biopsy confirmed. Serum from these individuals was sent to four different commercial laboratories for analysis, and the results from these labs were compared. The average tTG sensitivity overall was 71% with a specificity of 67%. In patients with total villous atrophy sensitivity was as high as 92%, and in those with only partial villous atrophy it was as low as 38%. One of the four laboratories tested samples from 48 of the patients and their sensitivity was only 51%, while the specificity was 100%. According to these results it appears that tTG testing—at least outside of the clinical study setting—may not be accurate, and its accuracy depends heavily on which lab is used. Unfortunately the researchers did not reveal the names of the commercial laboratories used in their study, but we hope they will do so when the study is published.