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Thu, 21 Aug 2008 11:08:52 -0400
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<<Disclaimer: Verify this information before applying it to your situation.>>

bs"d	

Summarization of my original question: I received first lab results back,
after being on a low to no gluten diet for 4-5 years. I was confused by the
first term, could not find out what it referred to exactly, as there are
several aliases. So I put the question to this community: ”What do the
following terms mean?”

Reticulin Abs, S
ARA
IgA Reticulin Antibody
IgG Reticulin Antibody

I then proceeded to describe some of the Mayo Medical Laboratories Celiac
Panel descriptions, complete with links.

A member responded that she has a friend, Holly, a librarian who works for
the NIH and trains people on how to use the free on-line educational
resources available thru the NIH and the National Library of Medicine. She
had sent my email to Holly, who replied:

Interesting. When I searched on the specific tests, I got little. When I
backed up and entered Celiac - there were very informative links to the
tests and their results.

http://www.nlm.nih.gov/medlineplus/celiacdisease.html

One of the links from this page goes to a website called "Lab Tests
Online: a public resource to clinical lab testing form the laboratory
professionals who do the testing."

http://www.labtestsonline.org/understanding/analytes/celiac_disease/test.html

LOTS of good definitions there.  (Cool site, got to remember this one.) I
highly recommend folks starting at MedlinePlus! Let me copy and paste for
you. (wow, very kind)

http://labtestsonline.org/understanding/analytes/celiac_disease/sample.html

Deborah’s note: Due to space restrictions I will only include the paragraphs
Holly copied that are very specifically relevant to my question. Because of
all the reading I'd done on my own via internet and some books looking for
this answer, as well as some repetitiveness and irrelevance of some of the
material to my specific question, I missed the importance of some of these
paragraphs Holly had sent to me. That's a word to the wise. She kindly
pointed them out to me.

# Anti-Reticulin Antibodies (ARA), IgA: Anti-ARA is not as specific or
sensitive as the other autoantibodies. It is found in about 60% of celiac
disease patients and about 25% of patients with dermatitis herpetiformis.

Each of the celiac blood tests measures the amount of a particular
autoantibody in the blood. For each test, both IgG (Immunoglobulin G) and
IgA (Immunoglobulin A) antibodies can be measured; however, few
laboratories offer IgG tests other than for gliadin. IgG and IgA are two
of the five classes of antibody proteins that the immune system creates in
response to a perceived threat.

In general, the IgA antibody is more specific for celiac disease (since
IgA is the type of antibody made in the intestine) and is measured almost
exclusively. IgG versions may be ordered either to complement the IgA
testing and/or ordered because someone has an overall deficiency in IgA.
This happens about 2% of the time with celiac disease and can lead to some
false negative test results.

From:

http://labtestsonline.org/understanding/analytes/celiac_disease/test.html

Positive and indeterminate celiac disease tests are usually followed by an
intestinal biopsy. A biopsy is used to make a definitive diagnosis of
Celiac disease.

That leads back to the question of "faint positive" she was asking about".
Hope this helps. Holly.
_______________________________________________________________________

And yes, that was wonderfully helpful. Hit the spot!!!

To summarize, if I understand this correctly:

It seems that if the lab report lists ARA, or “reticulin antibody” as one
component having been tested, this is the same component in the lab test as
IgA reticulin antibody. Thus, when being tested for Celiac disease, if
someone’s lab report does NOT specify which immunoglobulin is being tested
by the abbreviation IgG, then it is IgA. This is important, because IgA
reticulin antibody is specific, but not sensitive.

Regarding the reported specificity of IgA reticulin antibody, from other
sources that I have read, it will not show up in approximately 40% of those
with Celiac disease. It considered reliable predictor for Celiac disease,
approximately 60% of the time. Some consider it a very reliable predictor in
the case of latent Celiac disease. So, if you have a positive test result
for “IgA reticulin”, alias “antireticulin antibody”, alias ARA, alias
“reticulin antibody” you have a higher probability of having either active
or latent Celiac Disease. I'm not clear on which one it is considered an
accurate predictor for at this point. The source that Holly pointed me to,
referenced above only says that it is more specific than reticulin antibody IgG.

A couple sources I found in my quest:

http://www.jpgn.org/pt/re/jpgn/fulltext.00005176-199709000-00025.htm;jsessionid=Lt2CKLvpM2xzQsPjv1mGBQX1cmYSph4s7x3LxHhdQ3p1FXvk1vDF!526656812!181195628!8091!-1

http://www.gluten-free.org/hoggan/kumar.txt

Regarding the second link, I have been informed by a member of this
community that Hoggan is not considered "mainstream" in his views, so do
keep that in mind when reading his work. In my opinion, we need the
mainstream and non-mainstream folks in this game.

Thank you Carol and Holly. Feedback on whether I understand this correctly
or not is always appreciated.

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