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I'm very confused about how a positive antigliadin test should be handled when tTG and EMA are normal.  I have two children with a positive antigliadin (IgG) and now an online acquaintance with positive antigliadin IgA.  All have normal tTG and EMA.  

My mother, sister, one daughter and I all have CD.  We all had positive antigliadin IgG and tTG, and all had positive biopsies except me (I was on high doses of steroids at the time which made the results normal).  My other 2 children were negative for tTG, EMA, and antigliadin IgA, but had positive antigliadin IgG.  I have had them on a gluten-restricted diet (not gluten-free), hoping that it will reduce their chances of developing CD.  

In my friend's case, she has autoimmune hepatitis, lupus and chronic pancreatitis.  I suggested she be tested for CD, and only the antigliadin IgA is positive.  She is seeing her gastroenterologist in a week.

In searching for information about my childrens' results, I have been told and read various things:

1.  It's a false positive, don't worry about it.  However, a positive IgG antigliadin may indicate a wheat allergy.  (pediatric gastroenterologist).  
2.  Worry about it:  the IgA antibodies aren't too bad, but the IgG cause damage over time and why stress their system (pediatric allergist)
3.  They are not having an autoimmune reaction.  Don't put them on a gf diet now, but they should be re-tested in the future.  A gluten-restricted diet is a bad idea for them because it will obscure future test results.  (from University of Chicago).  
4.  There is no research on the subject, but a gluten-restricted diet sounds like a good idea (my gastroenterologist).
5.  I recently talked to a CD specialist about this (Dr. Murray at Mayo Clinic), and he told me that in family members with a CD-related HLA type, 10% will have positive biopsies.  I should have their HLA type done.  He doesn't believe in putting a child on a GF diet unless they have definite CD, but he thought it's possible that a gluten-restricted diet may reduce their chances of developing CD in childhood.  
6.  Ron Hoggan's book, which would appear to favor a GF diet for them.
7.  Some people appear to think that antigliadin alone is a sign of possible damage-others do not.  I've even seen some recommendations that the antigliadin test should be dropped as a screening tool - is there a controversy on this?  
8.  Several sources that point out that a large percentage of CD is missed by blood tests, and that antigliadin may catch more cases than tTG or EMA, such as:  
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12853995&dopt=Abstract

What is the experience of other list members?  What have doctors recommended for you if you had a positive antigliadin only?  Does it matter whether the positive test is the antigliadin IgA or IgG? 

Any information or personal experiences on this subject would be appreciated.  I will definitely summarize.

Diane Hosek
 

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