A new study on children with celiac disease finds that using anti-gliadin antibodies (AGA) to monitor dietary compliance is inaccurate. The authors report an increase in the amount of children who have negative test results to gliadin (the gluten component of wheat).
CONCLUSION: Serum AGA seem no longer useful for monitoring compliance to gluten-free diet. In children where AGA are negative at diagnosis, when the child eats a normal amount of gluten, they are going to remain negative even after poor compliance.
Minerva Pediatr. 2010 Apr;62(2):119-123.
Gluten Free Society’s Stance:
This is another example of how relying on blood tests can be misleading. AGA is a test that measures one’s immune response to gliadin. It is important to understand that gliadin is only found in wheat. Additionally, gliadin is only one component of gluten found in wheat. There are several others that are never tested. It is possible to react to these other proteins without ever reacting to gliadin. Consider the following:
- this study reported that almost 34% of the children diagnosed with celiac disease did not have positive anti-gliadin antibodies
- anti tissue transglutaminase (another common lab test to help identify gluten sensitivity) may only be positive 40% of the time
- antibody lab tests have a high rate of false negative results in the absence of villous atrophy (damage to the small intestine identified by microscope)
If blood tests and biopsy results commonly yield inaccurate results until the damage is severe, how do we take a preventative approach to gluten avoidance?
The answer lies in genetic testing. In the presence of symptoms associated with gluten sensitivity, gene testing is the most clinically accurate tool to identify the presence of gluten sensitivity. Mayo clinic has already started this trend. In patients with irritable bowel syndrome, HLA-DQ genetic testing is now being recommended as a primary tool to aid in the diagnosis of gluten induced IBS. Dr. Osborne, clinical director of Town Center Wellness in Sugar Land, TX has been using this approach for several years with tremendous clinical success.
Bottom line: You can wait for the gluten induced disease to become severe enough for blood tests and biopsy results to be positive, or you can be genetically tested and have and instant answer that will pre-date the onset of disease by years.