# IGA



## mrysgrl (May 9, 2002)

Hi,Does anyone know what it means if you don't have any IGA. My Gliadin IGG AB test was moderately positive. But the Antibody IGA and Antigliadin antibody panel were negative. I subsequently had a blood test to determine if I had IGA deficiency but they said I don't have any at all and that its normal.Thanks.Carol


----------



## Mike NoLomotil (Jun 6, 2000)

MRY-G:Oh boy this will take a few minutes to explain about IgA, the different kinds, the different body "compartments", and then what those tests mean in a way that will make sense to you.I have got to go it is almost 10 am. But in the meantime for starters, the "humoral" immune system, antibodies, is divided into 5 classes (IgA, IgD, IgE, IgG, and IgM). Ig stands for immunoglobulin.Pathogens and their toxins are "eliminated" by antibodies. IgM, IgA, and IgG are the main ones present in blood, lymph, connective tissues, even the gut. Are secreted by from lymph nodes, spleen, bone into the blood where they circulate. At sies of infection and inflamation the blood vessels are dilated and aloow an increase in flow thus an increase in the local supply of the antibodies needed. They can actually leave the vessels and got into the tissues where thyey bind to bacteria and viruses as part of the cascade of prtective immune repsonse. IgA is also made in lympoidal tissue and the mucosal linings of organs and then selectively transported to bind with pathogens "outside" the tissues, like on the surface of the mucosa int he gut for example.Now when I come back in the morining I will try to explain exactly what the tests you had do and do not mean and why so you are more clear...as we have to go into the antgliadin explanation too.Sorry I gotta run but I promise to come back tomorrow I am just booked the rest of the day starting now!







MNL


----------



## mrysgrl (May 9, 2002)

Thanks!!!!!!!


----------



## Mike NoLomotil (Jun 6, 2000)

Sorry I did not get back yesterday but by the time work was done the Dolphins-Jets game was on and, well, there are priorities for us "Fish Freaks".Heh heh







heh what jinx? Run Ricky RunOk anyway so now you understand what IgA in general does and where it is and that you should therefore see some in the plasma what does it mean if it is not there? Sometimes a mild problem sometimes no problem. If a person has an IgA deficiency they usually make up for it by making more of the other Immunoglobulins. I think the rate at which this occurs is so low it less than one fourth of one percent of the population. Sometimes a person can have symptoms that appear to be allergy, or GI discomforts like diarrhea as a result. Sometimes a person might also have an "IgG deficiency" as well so they check for that. What you are trying to find is a profile that says the person has intact immune function in spite of the IgA deficiency. If so then there is little to cause worry. They also have to check and make sure that the person does not form ANTI IgA antibodies&#8230;think of it this way&#8230;your body does not "make" IgA like it should so the sometimes the rest of the immune system malfunctions and can form antibodies AGAINST IgA as if it were a foreign substance. SO that is a kind of "auto-immune" problem then. So the MD beleives you to have "intact immune function" and NO anti-IgA antibody there was in the doc's view no cause for alarm in that regard.Now simetimes people with primary IgA deficiency can develop "celiac sprue" disease [as it is commonly called] as a comorbidity...this is where IgG antibodies are formed against "gluten" and you get as you know sick bowels and some damage to the tissues as result.You say that the Gliadin IgG antibody test was "moderately positive". Did they do another test called AEA or "antiendomysial antibody test" too or not? If so what were the results?Also what symptoms do you have and when did they start?As an aside these explanations will appear, to anyone who is an "immunology expert", incomplete and oversimplified. This is a bit of a complicated area (humoral immunity) and I have worked hard for years to grasp even a rudimentary understanding myself&#8230;but this is just to make it as simple as possible for you so you do not worry.Anyway I will come back tomorrow to continue.MNLPSKudos To Browns, too!


----------



## mrysgrl (May 9, 2002)

Thanks so much.Over the telephone, the assistant said I didn't have "any" but they faxed me a copy today and this is what it showed:Immunoglobulins A/E/G/M, SerumImmunoglobulin G, quant,Seru 879 mg/dL (700-1600)Immunoglobulin A, quant,Seru 175 mg/dL (70-400)The next one has a *>* and is highlighted so can't really see it on the fax but it seems to be that the Immunoglobulin M, quant Seru is a negative number? If that makes any sense.The IGE, Qn was 36 IU/mL (0-79)My symptoms started at 17 (foul gas, weight loss, constipation, abdominal swelling and my intestines are so stuck together deep in my pelvis that doctors keep asking me when did I have abdominal surgery (never). In January, after using mesalamine, I had a severe episode where I couldn't stand up and my blood pressure dropped, and I had severe back pain. (The doctor who I subsequently saw suggested it was a touch of proctitis?)I thought it was interesting that the LEAP test picked up the problem with barley, wheat, oat so clearly. Why aren't more places using it along with the other tests currently in use. I think resistance by doctors to a # of new tests available is doing their patients harm. And it really doesn't seem that the doctors' resistance is based on any research or analysis?Your help is appreciated. Carol


----------



## Mike NoLomotil (Jun 6, 2000)

She said you didn't have "any" from those test results?I think that you should discuss this with that doctor the next time you see him/her. People should not be assigned to give patients test results who are incompetent to do so and to answer questions.Thats just plain stupid, this is medicine not Jiffy-freakin Lube!







______________________________________________"I thought it was interesting that the LEAP test picked up the problem with barley, wheat, oat so clearly. Why aren't more places using it along with the other tests currently in use" ______________________________________________The assay was developed to detect in vitro ANY mediator release from the immunocytes in the sample, which is "heterogenous" plasma and white cells. So if there is any reaction at all of the circultaing immunocytes it will detect it and scale it quantitatively.By using the patients own blood as the control, you can get an idea of the degree of reactivity since the device will first look at multiple samples of subject blood exposed to nothing but the lysing agent (gets rid of the red cells) and the diluent to see the normal range of variance from sample to sample (in the change in extracellular fluid, movement from inside the cells to outside the cells...it is very logical and easy to envision since this is the end game of any reaction: mediator release from the cells). When you expose the cells to minute amounts of the extracts nothing should happen...it's food it's safe..unless the dilutions are wrong of course but after 10 years and literaly millions of runs, the dilutions are pretty well dialed-in for the 150 substances tested. If something does happen, then, this should be and is considered very suspicious as a possbile symptom generator so the plan then begins with excluding all those and only consuming those which showed literally NIL response compared to the patients own control samples. Physiologic logic prevails.The development of the test and the protocol ran from about 1993 to 2000 and the US patents issued the end of that year so this is a very recent innovation. The development was done in private clinics we set up in south Florida where the doctors and dieticians worked only on devising protocols based upon the test and other known procedures for isolating pseudoallergy, for example (which does not show up on any assay when it happens in the gut mucosa) and stress reduction methods which patients could impleemnt at home...then how to integrate all of them to get the best results and how to properly select the patients who would benefit so that people who could not would not be wasting their money.So it just "got out" at first when Snow Birds wintering down here with IBS or migraines for example went back home and their doctors would call and demand to know what was done with this diet thing and this test thing to their patients....who now were a lot less symptomatic. these were basically the first doctors to start trying-out the method.It is only in the last 6 MONTHS that we have actually seriously started actively putting consultants out there trained to show it to primary care physicians in other places so this is the main reason that more have not heard yet. Its just new.Also we do have several of these doctors who, in addition to just treating their patients, are also "collecting" the before-and-after symptom data on their patients. Soon there will be enough cases from "independent parties" over a long enough period of time to asemble the outcome data and publicize that it. Then it will start to hit the literature and start getting known. Since it (IBS) is considered to be a symptom based diagnosis (the Gold Standard set by the "opinion leaders" at this time) and patient progress is thus appropriately assessed and scaled by symptom reduction, then it is not a difficult matter to show outcomes over time. But you need to follow the patients out for progress over months, two months, three months, four months etc. so as to ensure you can see the recidivism rate and the mid-term and long term outcomes and to to minimize the "placebo" issue which doubters are so fond of pontificating about as if this is the only rationale for good outcomes in IBS dietary therapy.But I think you can read enough patients around here who have experienced symptom suppression for longer and longer periods of time to be able to reasonably conclude that placebo is not the explanation. Also since it has been shown clearly that cellular inflammatory reactions really do occur in the small bowel (in vivo discoveries) and it has already been published by a third party in europe that the MRT test LEAP isbased on accurately detetcted the cellular reactions of the subjects selected (proven milk sensitive)even in its 1997 version (improvements are made continuosly) then it all adds up to a picture which is reasonable enough that nearly 300 insurance plans so far have paid for it and more doctors are using it each day as they try it out on a couple of their patients and see the results.Little private R&D companies with new technologies that they paid to develop themselves, using bootstrap private capital, tend to grow more slowly than those with billions in the bank...many fail.







We however have gotten past that critical point..so that growth, while slow, will continue within the confines of our available resources.







MNL


----------



## mrysgrl (May 9, 2002)

Thanks again. I didn't mean for you to go to all that trouble, but your replies have been a big help! The elimination of the red and yellows has really improved things. I am adding ibsacol for a trial as well.In all fairness, it really wasn't the assistant's fault. They get so busy there. She made a point of bringing the results to the doctor's attention because she didn't know what they were looking for. I think she just meant there was an abnormality with the IgM and it came out wrong because I could hear everything in the background and it is a difficult job. When I asked for a fax copy, she sent it right away. It is probably my fault, at this point, I find doctors so intimidating/frustrating, I am timid about asking any questions anymore. I got that ibs/stress/its all in your head answer for too many years. Its very demoralizing. I showed a patient excerpt from my LEAP results to one doctor and he seemed to recognize its value and to continue with it. I think it helps alleviate peoples' suffering regardless of the underlying cause. I guess it just takes time for new things to be accepted. Change is difficult for all of us.I will follow-up at my December appointment and go from there.Take care. Don't forget to rotate your foods while on all those road trips!Carol


----------



## Mike NoLomotil (Jun 6, 2000)

Carol.1. No trouble at all.2. yeah, failing to rotatemy foods on my own road trip, I gues is a good application of being "hoist on my own petard"







Ouch. or is it 'Duh'.MNLI guess I could rotate Wendy's burgers and Checkers burgers, si?


----------



## mrysgrl (May 9, 2002)

I didn't mean that in a critical way. It must be incredibly hard to stay on your diet while traveling. I've started keeping a bag with raw almonds, apples, and pears in my car so I can hopefully stick to diet better. They seem to hide barley in an awful lot of products as I have found out the hard way. But it is such a relief to know the reason when I do feel crummy. Thanks!!Carol


----------



## Mike NoLomotil (Jun 6, 2000)

Oh don't worry I did not take it in a negative way at all!If I was my dietician I would have chewed myself out. Oh I am. I did.







The travel bag is a raal good idea. Normally I do 2 things which minimize the problem, but on a recent trip I did not and screwed up:1. Make sure the destination hotel if at all possible is an extended stay type hotel where I have a kitchenette...problem solved2. Take a cooler along with stuff I can eat along the way and for the first day of arrrival so when I get in I don't have to run right out to the grocery store.The hard part is usually the hotel/motel stops along the way...you see how far you got and pick from what is there that you belong to the "frequent user plan" for. The highway huggers usually do not have much in the way of efficiencies so you end up looking at a Waffle House and a string of burger joints with the occassional Bob Evans Country Poison Center or Pizza [insert chain name] through the hotel window.Or sometimes there are such delights as "Goober's South Carolina Pulled Pork Barbecue Pit" or "Tai Fong Zit Chinese Monster Buffet". Warning, Will Robinson!!!Also, always beware any restaurant near the highway with the words "Seafood" ANYWHERE in the name. Especially if you are in West Virginia or Kentucky.Oh and that "bountiful breakfast buffet included" of dried up bagels, brown-water-coffee and Sara Lee Danish!!! To die for.







Literally!Take Care Carol







MNL


----------



## Julia37 (May 9, 2001)

> quote:Bob Evans Country Poison Center


At Indy last year there was a Poison Center and a Denny's across the street, those were the choices for breakfast. I checked and the BE does not serve ANYTHING that doesn't contain soy oil! The only exception was oatmeal, and they stopped serving that around 11am, which is around the time I got up. BTW, the stuff they called "butter" is margarine.So all my friends were eating pancakes and such at BE, and I was at Denny's with a bowl of grits and side of bacon. On the bright side I did get to eat dinners at the Fountain Square Diner - yummy burgers, hash browns cooked in butter.


----------



## Mike NoLomotil (Jun 6, 2000)

Hashbrowns cooked in butter.







Damn I wish I could tolerate potatoes. Funny how much you can miss a simple spud, and all its myriad incarnations!MNL


----------



## Julia37 (May 9, 2001)

Mike, I'm sorry! I didn't know you're intolerant of potatos. It's one of my favorite foods.I've always eaten a lot of starches because they help prevent and soothe spasms, and potato is one of my favorites. If I need a snack while I'm out, I can make do with Jay's chips - cooked in corn oil, yay!BTW I've been noticing lately how and when stress triggers spasms for me, and taking steps to correct it. One big one is dealing with health insurance. I can have a complete PTS meltdown if I'm not careful.


----------



## mrysgrl (May 9, 2002)

Got things straight now I hope. My IgG antibody test (part of celiac test) was elevated and my IgM serum level is elevated about 30 point above top of reference range.


----------



## Mike NoLomotil (Jun 6, 2000)

J....yeah once one has "upregulated" the gut, whatever the primary mechanism, the normal reactions to added stress or anxiety are amplified. If this is a result of diet provocation, then the stress stimuli are like throwing kersoene on a fire. The inverse is also true. So if you attenuate either effect you can reduce the symptoms. Attenuate both and get double the fun.Girlie...It is very difficult for a lay person in particualr to evaluate immunoassays in a vacuum from the entire clinical picture, history, and other tests. But I can explain in general, for example, that IgM can eb thought of as an antibody which helps keep things under control in the bloodstream (pathogens)...it helps protect that part of the body from pathogens, and works to help activate other mechanisms, like complement and macrophages ("eating cells") which are part of certain immunoprotective response to "invasion". So that result can be interpreted many different ways and possibilities.Esp. when combined with the IgG result you mentioned. Now it would be easier, in a way, to interpret if the IgG were abnormally low as this creates a certain "picture" which flashes to th mind of the physician when seen but this is not the case here. IgG can be thought of as the principal immunoglobulin of seeondary immune response as it creates a certain kind of "memory" gainst pathogens. It is found throughout the body tissues not just in the blood. There are different classes of IgG which do dofferent things, so you also have to assess those to try to interpret any abnormalities which are seen.Were these tests adminstyered and interpreted by an alergist-immunologist who is bnoard certified, or by some othee physician? What was, ultimatley, the interpretation in the context of your history, physical, and other lab findings?MNL


----------



## mrysgrl (May 9, 2002)

I don't know what an immunologist is. Have I had an untreated infection for 27 of my 44 years, I wonder. I will have to try to find an immunologist.P.S. I really, really want spaghetti with meatballs and italian bread with lots of butter.(I am in my eighth week of gluten free and all of a sudden getting terrible cravings).







P.P.S. I have been finding that taking 3 grams of omega-3 fish oil (That I started taking since recommended for crohn's) seems to be helpful in reducing flare-ups that result from accidentally eating "hidden" red/yellows. Do you think this could be due to the ant-inflammatory effect of fish oil? Thanks again.Carol


----------



## Mike NoLomotil (Jun 6, 2000)

Carolita:1. It might not hurt to let an allergist/immunologist look at your chart and comment...might put your mind at ease. There is also simply the possibility that, besides the Crohn's, one of your other "sensitivity" mechanisms is that you have activated those mechanisms. The cascade of reactions which can occur in non-IgE mediated reactions is amazingly varied and not wel understood...in some cases (in simple terms) the reactions actually seem to run contrary to what has been classically "believed" about certain immunologic responses and mechanisms. Food and chemical hypersensitivity is a consequence of what happens in Crohns, not the causal basis...it aggravates the underlying condition and occurs as a consewuence of the specific lesions and infammatory activity.Hey, I forgot your profile and am rushing around...where do you live..maybe the guys I know know someone in your area who is an 'aspirant' of these pursuits.2. Do not even TALK to me about pasta!!!







I have not had a big bowl of spaghetti and meatblass for at least 4-5 years now. I used to eat italian at least 5 times a week. I still get, uh, nervous when the kids slide their raviolis around their plates...its sike they are taunting me. Not the kids, the raviolis!"look at us MNL,how red, how meaty, how cheesie!how perky, how tasty! So sorry for you...OH OH here comes the FORK! There weGOOO!!! Not in YOUR MOUTH though! Nya nya nya!"However, I gave also not suffered the consequences either...I think italian food to us is like cravings for an addict to anything. Like my cigarette habit I am just one smoke away from starting again, or the ex-MrsNL whow as always one drink away from drinking again...trouble is she never managed to get farther from it than thatd rink, and she kept swallowing it







. Oh well....3. yes long chain and super long chain fatty acids are known to have attenuating effects upon certain types of inflammatory reactions...and since there are cellular and/or mucosal reactions involved in symptom generation in multiple ways in your case, depending upon your specific reaction profile you may indeed experience blunting of symptoms by ingesting long chain fatty acids. This is also the general theorum behind supplements like IBSACOL and some others out there.If it seems to be helping I do encourage you to continue...there is sound basis for this in the literature.MNoLinguini


----------



## mrysgrl (May 9, 2002)

Thanks, I am in Phila, PA so close to anyone in Phila area or S. Jersey area.I have wondered about alcohol problems and whether there is a partial food sensitivity (barley/wheat, grains,) problem going on there. Don't drink because the effect of even one beer on me is profoundly different from the norm. Have noticed that the combination of g.i. problems and alcoholism run very clearly in my father's relatives. It can be very, very hard on the family, sorry you went through that. I kind of wonder if the IgG/IgM business is related to infection with klebsiella (just recently took cipro) and blastocystis hominis (many per report) which I understand is controversial. Thanks. Carol


----------

