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Subject:
From:
Melissa Mannon <[log in to unmask]>
Reply To:
Melissa Mannon <[log in to unmask]>
Date:
Tue, 9 Oct 2007 21:19:57 -0400
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<<Disclaimer: Verify this information before applying it to your situation.>>

Hi again everyone,  

Thank you all so much for your responses!  Thank you for confirming
unanimously what I suspected.  I had about twenty people write to me and
I've tried to summarize all of your replies below. I hope that I did okay. 
I am still working with the original pediatrician on our case who is an
extremely open minded, wonderful guy, and willing to collaborate with me. 
But I have also added the naturopathic doctor who diagnosed me 5 years ago
to our team.  We are proceeding with new blood work tomorrow. We have also
formulated a plan about what to do with our findings - whether positive or
negative. All of the info. you provided me helped us with this plan.

So here it is...I hope it helps others too.

Everyone said there should not be a problem retesting a child after only one
week gf.

Unanimously respondents said that tests that should be done are the same for
kids and adults.

Antibody test results can be particularly unreliable for kids under 3 (some
said under 7)

Some recommended genetic testing.  If positive then reason for symptoms is
obvious

Serological tests are sometimes unreliable and some believe biopsy is
necessary no matter what

Many emphasized that IgA levels can be deficient in Celiacs and therefore a
general IgA test is unreliable (see comments quoted below)

Recommended research centers for more info.
Columbia U.
University of Wisconsin GI Clinic
University of Chicago Celiac Disease Program (doctor in charge is a pedi-GI)
U. Maryland

MANY people recommended Enterolab testing.  One person said that kids are
sometimes too young to test positive through bloodwork or biopsy and
therefore stool testing is best.

These web sites were recommended:
http://www.glutensensitivity.net/ 
http://www.celiac.com/st_main.html?p_catid=8
http://www.celiacdisease.net


Quotes that I found particularly noteworthy:

- “…at the Clinical portion of the Internation Celiac Symposium in NYC last
fall, Dr. Michelle Pietzak said she tests kids for using both IgA & IgG
antibodies since some children don't start producing the IgA antibodies
until they are about 7.  If the IgG antibodies are high, she biopsies and
does find damage to dx celiac..”


- “If your child is IgA deficient as many celiacs are, none of the IgA
testing will be positive as there is not enough antibody material to
register a reaction.  Doctor would need to order a total IgA level of
circulating blood to rule this problem out.
 
In our family, 3 adults and 1 child (age 4 at the time) all were IgA
deficient----and blood work was negative.  All had positive biopsies and
were diagnosed as celiac based on biopsy.  All have had symptoms resolve and
are doing well.  Child was anemic, low body weight, reluctant to eat due to
discomfort and had fatty diarrhea.  She is 16 now and has boundless energy,
diarrhea cleared up, and no anemia.  We are very thankful to Dr. Fasano at
U. Maryland for diagnosing her.
 
Medical researchers and celiac doctors would not agree with your pediatrician.”

-  “...So, to summarize, testing for the presence of tTG-IgA antibodies and
Deamidated Gliadin Peptide antibodies, (the new gliadin test),  is
sufficient if the child is old enough to produce normal levels of IgA and
they are not IgA deficient.  If either of these is not true, further testing
is in order.  Specifically, performing the same tests but looking for IgG
mediated antibodies rather than IgA because research shows that people with
the specific IgA deficiency who are celiac disease patients will have IgG
antibodies to these targets.”

- My son is IgA deficient, so he would get a false negative result of celiac
disease if he were only tested using IgA.  The celiac patient has a higher
probability of being IgA deficient than the general population.  It is for
this reason that total IgA serum levels must also be tested in the patient.
 I refer you to Celiac Disease A Hidden Epidemic, by Peter Green, MD, for a
list of the tests needed for a true and complete diagnosis...It says you
need to test IgA EMA,    IgA tTG,    IgG tTg, and total serum IgA antibodies
to identify celiac disease in symptomatic patients who happen to be IgA
deficient."

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