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I figured this is the best group to ask.

Back story- my 6 yr old son has autism. He is not toilet trained as he has never been able to successfully recognize the urge to go and connect that to going to the toilet. Pedi referred us to urology to ensure there wasnt a physical problem being missed.
Urologist was quite annoying as her only real suggestions were the usual methods (promise him fun underpants, sticker reward chart, take him on a schedule) that I had already told her we had tried previously with no luck, but she did send him for an abdominal xray and bloodwork.
I was initially told bloodwork was normal and xray showed stool that needed to be cleaned out, and that he should take miralax daily until further notice. When I questioned why this would be and couldnt get a call back I called his regular pedi's office who promptly had a nurse call me. She agreed with me that before starting a daily laxative we might want to figure out the root cause especially since he has no known history of holding BMs in and infact has a daily soft but normal volume BM. We also noted that his IgA test was low, reference range on the report is 33-235 and his is 10.
She has handed this off to pedi and she is supposed to call me monday to discuss before we do anything else including the clean out and daily miralax.

However- my question is this. I asked a friend who is a nurse if she knew anything about IgA and she pointed out that IgA deficiency can be genetic and can be associated with allergies, asthma, and autoimmune disorders. She did mention having heard at some point that low IgA could be associated with IBD. Im wondering if any of your kiddos have had this test and if so was it low?

(we are naturally concerned given my crohns DX and the fact that my 9 yr old daughter and i are also both asthmatic though neither of us have ever specifically had IgA tested)
 
I should note that one of the things Im intending to bring up with the pedi when she calls me is the idea of a possible referral to a GI doc to investigate a bit further what if anything might be going on
 
I'm not an expert on IgA, but I do know my son with Crohn's is on the other end of the spectrum... his is too high.

I'd be interested to hear what your Ped says. If he's pooping normally and feels fine, why add Miralax?
 
Pedi's nurse called today. She doesnt feel like the xray is indication enough to put him on miralax especially in the absence of abdominal pain, nausea, lack of BMs, or any other symptoms indicating he feels anything other than normal. She did agree that given the bloodwork and my history that a referral to a GI just for a 2nd opinion wasnt a bad idea and is setting that up now, but for now ive been given the green light to hold off on miralax given the uncertainty. Xray showed "moderate stool burden throughout colon" but a "non obstructive gas pattern" . CRP on bloodwork was normal, MCV/MCH were high end of normal but within normal range, as were t4 and TSH. Celiac antibody screen was neg, but as mentioned IgA can cause false neg. the only flag was the low IgA.
 
In preparation for the GI visit, I would see if ped would go ahead and order a fecal calprotectin test to compliment all the blood testing. Simple, non invasive and just another indicator of intestinal inflammation should inflammation not show in blood.
 
that is a good idea. Will put in a call on that. the CRP didnt indicate but Im learning that that isnt always the end all be all of inflammation markers.

At this point, My biggest concern is that the IgA deficiency might be masking celiac. But obviously, given issues related to bowels and my history I want to be sure we arent missing something for him.
 
Sometimes a high FC will indicate Celiac as well. It isn't necessary to have a high FC to get a celiac dx nor do all Celiacs have a high FC but if the FC is high it would certainly move you to more testing and closer to answers.
 

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