Help Understanding Celiac Panel Results For 1Yr Old Daughter

[JamieCarin]

Just a quick sum up. My daughter is 13M old and has dropped from around 58th% to no below 0% for weight. She is just 16lbs. She eats well but she suffers from chronic constipation. With the major weight drop our pediatrician ordered some labs including a celiac panel. I was wondering if someone could help me understand the results. Specifically if she would be considered IgA deficient??

Tissue Transglutaminase Antibody, IGA: <3 (this says the test is negative...over 8 is positive)

Gliadin Antibody (IGA): 5 (this also says negative and over 17 is positive

Immunoglobulin A: 7 (this says "out of range" with a reference range of 24-121)

I don't know if it is helpful to know that it was Quest Diagnostic who did the testing.

Thank you!!

[ravenwoodglass]

It does look like she may be IGA deficient, if I am reading the test correctly. False negatives are not uncommon especially with children. There are IGG tests which can be done, they might be helpful so ask your doctor about them. After you are done with all testing a trial of the gluten free diet for a few months would be in order.

[JamieCarin]

Thanks for your reply. How does one figure out/know if it is indeed IgA deficient? I have seen other people mention this and they seem to have a different reference range. I haven't gotten to speak to her doctor yet as I got these results Friday afternoon after the office was closed. I am just so anxious to get to the bottom of my daughter's issues. And I also want to make sure that what my doctor tells us is correct!

Thanks

Jamie

[Gardening]

There is a different reference range, because adults produce more IGA than young children.

If her total IGA is below the range, then yes, she is IGA deficient.

My 4 year old has a total IGA of 21, but her age-adjusted range starts at 27. Her pediatric GI considers her to be IGA deficient, and therefore the celiac panel is not a valid test for her. It's true that they can run some IGG tests, but it is not that accurate for celiac.

Honestly, I think it's time to take her to a GI (preferably one who specializes in children). Failure to Thrive is a good enough reason on its own, but especially with the constipation. My experience is that too many pediatricians try to handle big problems on their own, without referring to specialists, but many issues are really outside of the scope of their expertise.

I would not try a gluten-free diet without first seeing a GI, and seeing if they want to scope her.

[JamieCarin]

Gardening thank you for your reply!!

This is a brand new pediatrician who offered immediately to refer us to a GI but also gave me the option of just running some bloodwork first to see what we can find and then to go from there. I opted for the less invasive/intense bloodwork option first. (she was also tested for thyroid issues, liver issues, metabolic panel, etc....all of that came back normal. This was the only thing that was off...the low IgA)

My son has the same issues. His weight is generally more stable, but he is 5th% for weight, has eczema, and was just diagnosed with an egg allergy. But same constipation issues as my daughter. He is 2.5yrs old.

Consindering her weight I suppose she would be considered failure to thrive? Developmentally she is right on track. She is walking and meets all of her milestones etc. She is just absolutely tiny though.

How do I know what my daughter's age adjusted reference range should be for the IgA? Is it adjusted automatically by lab on the results?

Can I ask you what the IGG sensitivies in your signature mean? I have suspected some sort of dairy sensitivity with my kids, is that the sort of thing that is referring to and can that be tested for?

[Gardening]

JamieCarin -

As long as the lab report has the correct age listed, then it should automatically give the correct range for her age. I don't have my personal labs in front of me, but my range is much, much higher and my actual number is something like 260, which would be waaaay high according to your daughter's range, but pretty much in the middle of mine. So her range looks correct to me.

Failure to thrive refers only to growth charts - they can be completely perfect otherwise. I've heard both 3rd percentile and actually falling off the charts as being the definition of failure to thrive. My GI actually listed FTT as one of the official reasons for the endoscopy/colonoscopy for my 2.5 year old, who is actually at the 25th percentile - but she was 97th or actually off the charts on the top end for her first 6 months of life. So in this case, it was the falling down the charts that was the reason for concern. But, she's brilliant and super strong She's certainly "thriving"!

A traditional allergy test is either a skin prick/scratch test or a RAST/IGE test. It measures the number of immunoglobin E's that your body makes to something. This is how you measure an allergy like... shellfish give you hives or peanuts make your throat close up.

An IGG test is one that most allergists think is BS. Some nutritionists, naturopaths, and alternative MDs use them. They are not perfect tests, but can give a clue as to which foods to try to eliminate to see if you get a response. There is something called non-IGE mediated allergies - this is medically recognized - but there is no perfect test for it. The only true test is eliminating it and then monitoring the response (and then doing a challenge where you give it to someone after not having it for 6 months and then see if they react).

So, for traditional testing, if you think your kids have a problem with milk, you could get an IGE/RAST test run against casein, which is the protein in milk, and you could also get a lactose tolerance test run (it's like... a breath test or something?). Lactose intolerance and casein allergy are totally different things, though both would show up with drinking cow's milk.

Hope that helps!

[JamieCarin]

Gardening thank you so much for all of this info! Invaluable!

Well then I guess Anna would be labeled failure to thrive as the doc said she is now below zero. She was at 3% at her 9M checkup. I am very anxious to see what, if any, change in weight there will be at her weight check in a few weeks. He told us to work at buttering her up so we have been giving her lots of high fat foods etc. I can't say I SEE a difference in her weight, but we shall see.

My son had the scratch test for casein (and the basic allergic foods and environmental stuff). Just egg and cats came back as positive. He also had the RAST test for egg. I am fairly certain the problem isn't lactose related. I am lactose intolerant and they have totally different issues. With the constipation and the skin. I have been hemming and hawing about eliminating dairy. Right now yogurt is one of the few things I can get my son to eat with some regularity. Egg seemed totally doable in terms of cutting out. Dairy and gluten both seem like overwhelming endeavors. Of course this is not a good reason not to try it.

Thank you again for all of the info and letting me ramble on to you!!

[ravenwoodglass]

Dairy and gluten both seem like overwhelming endeavors. Of course this is not a good reason not to try it.

Thank you again for all of the info and letting me ramble on to you!!

The effort will be so worth the trouble when the kids are growing and thriving again. You might want to consider making the whole house gluten free. Many of us are thought to be lactose intolerant when it is really gluten we have an issue with. The same area damaged by gluten is the area that produces the enzyme that helps us to digest dairy. Once the intestines heal many are able to go back to dairy again. Since the lactose intolerance causes basically quick reactions while with gluten the reactions can be delayed dairy gets the blame for many of us. I was sooooo happy when I realized that yes I could eat ice cream again.

[JamieCarin]

just wanted to update if anyone is following. Spoke to the pediatrician and he wants her celiac panel run again to see if the IgA still comes back low. If it does he wants to refer her to an immunologist (???)

[nora-n]

No need for immunologist, as it is not uncommon for celiacs to be IgA deficient.

And, being IgA deficient is actually one of the hints about celiac.

Now the IgA type tests, any IgA based tests, are not valid if the IgA is low, even inside the range, just low within the range, since the results are dependent on the actual level of IgA.

Here in Europe, the total IgA is always run with celiac tests, and if the total IgA is low, they run the IgG versions of the same tests.

With your daughter, they should have automatically done the ttg IgG, and the antigliadin IgG, and the deamidated gliadin IgG. They would have automatically done that here.