Thoughts on IgA?

[Mehita]

DS had a Celiac panel run at his last infusion, just for kicks. I know the Celiac tests are all looked at together for a big picture, but his IgA test on its own was really high. It came back at 511 and normal is 50-330. Could this be due to Remicade and how it affects the immune system?

I'm Googling, but not coming up with much. His GI posted the results online with no comment so I'm assuming he's not concerned.

Any ideas?

 

[Mehita]

I just pulled up older records and he also had an IgA run a couple of years ago when he was on Pentasa only, so I'm guessing it's not Remicade related.

Maybe it's just because he has Crohn's?

 

[Trysha]

It may need further immunological studies to put the significance into perspective.
The studies would best be done by an immunologist.,skilled in the art and science of
the immunoglobulins and the important function they play in the body.
I would not be happy to have this level of IGA and would be asking for a hematologist
consult.
Trysha

 

[kimmidwife]

Mehita,
I have to second Trysha. Sounds like you need an appt with an imunologist. I hate when docs are nonchalant about things!

 

[Catherine]

This is all I could find.

http://www.australianprescriber.com/magazine/24/2/38/40/

 

[Momtotwo]

I have a high IGA, and I was referred to a hematologist. The hematologist has been unable to find the cause of the IGA, but it is assumed that is due to inflammation related to my autoimmune condition (not IBD). I assume Crohn's itself could be the cause of an elevated IGA. However, a hematologist would have to rule out other causes before assume it's related to a person's known autoimmune disorder. I had to get a baseline 24 hour urine and I get many tubes of blood drawn annually. As long as my IGA remains relatively stable, it doesn't suppress the IgM and IgG and my other tests are normal (CBC, CMP, SPEP, etc.), the hematologist isn't concerned.

I would definitely suggest a hematology consult. If you have success getting an immunologist to explore it, please share. That seemed like a logical choice to me, but I was told the immunologist would assess a low IgA but wouldn't know what to do about a high one. (The immunologist told me that.)

 

[Momtotwo]

Was the result when it was checked last time? Recent infections, immunization and other things can cause an increase in IgA. If the previous one was normal, it might be worth rechecking next month before seeing a specialist.

 

[Mehita]

After reading Catherine's link, I'm wondering if it's high due to the double whammy of Celiac and Crohn's. I can't find any info that says if disease activity is under control that IgA would drop or change. Maybe this is just normal for him? I need to dig into his old records because I think its been tested before but it's under a different name.

His GI said it is an acute phase reactanct, meaning is can be elevated for inflammation or infection, but becaue his other labs looked great, they are not concerned.

My other son's allergist specializes in immunology and also has Crohn's herself. I think I'm going to start there. He needs allergy testing done before spring anyway.

Thanks for all the input, everyone!

 

[Momtotwo]

Mehita,
Good luck with everything. Please share what you learn! When I see my hematologist, I will ask about Crohn's/IgA, too and will tell you what the dr says. I wish I could find an allergist who specialized in immunology for both my son and for me. In this area, it doesn't seem to exist.

 

[Catherine]

Is this the test we are talking about?

http://www.dhm.com.au/media/297757/coeliac.pdf

IgA and IgG Gliadin Antibody Assays
IgA and IgG antibodies can be detected by ELISA tests. The results are reported in units over a “cut-off”. The numbers
or values of these results exhibit a good dynamic range of values. They mainly have utility for monitoring compliance with gluten-free diets in patients. Usually IgA gliadin antibodies are negative after 6-9 months of a gluten-free diet (normal <25 U/mL).

 

[my little penguin]

All allergist are immunologists .
But not all immunologists are allergists since allergy is a sub speciality of immunology .

 

[DanceMom]

Our Rheumatologist is also an Immunologist. His wife is an Allergist/Immunologist. Our doctor seems to specialize more in Rheumo stuff so I'd love to see a doc that sees only PID kids. Just for another opinion and to make sure all bases are being covered.

 

[Momtotwo]

MLP- all allergists are immunologist but very few (in this area at least) practice immunology that extends beyond allergies. It's been a major frustration for me. My dr is is a group of 12 and they all treat allergies.

 

[Mehita]

My cousin is a family med doc and this is what he said...

"I looked up IgA on UpToDate (an excellent resource that also has a patient section on many other topics at www.uptodate.com), and I could not find anything about higher levels other than being associated with inflammatory and some autoimmune conditions. My expectation is that it is just part of his known celiac disease and not an indicator of anything else to be worried about. As long as GI is not concerned, I would not be either. I expect that they are not seeing any evidence of nephropathy, and an immunologist would only need to be involved if the levels were low indicating an immune deficiency. Feel free to verify everything I have written with the gastroenterologist as this is certainly not a test I order much. I can also run it by one of our specialists before you go through the trouble of making an appointment if you like."

Our pediatrician had a similar opinion.

Like I said above, we need to do allergy testing anyway, so I'll ask for an opinion there, maybe even run the IgA again, and see what she thinks.

If I have four doctors telling me nothing is wrong, I'll go with it. My momma gut is pretty fine tuned after all these years and it's not throwing any alarms out. Back to the bubble, I think...