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July 16, 2005

Other Illnesses

Question from McDonough, Georgia, USA:

Because of frequent stomach aches and headaches, my daughter had a celiac screening at her last visit with the endocrinologist. We were just informed the test was negative, but showed an Immunoglobulin A Deficiency (laboratory reading of 4 with 41 to 368 being the normal range), for which we are now being referred to a gastrointestinal (GI) specialist. I was wondering if someone could tell me more about it. Is it something common in children with diabetes? How is it treated? Is it something we should be concerned about at this point? Our diabetes nurse educator really couldn't tell me much about it, other than it can cause false readings on the celiac test. We have an appointment with the pediatric GI specialist tomorrow, but have no idea what to expect. Any additional information anyone might have would be greatly appreciated.


You have a wise diabetology team that is screening for celiac disease in those with type 1 diabetes. Celiac occurs in about 5 to 8% of type 1 diabetes patients and is often silent, but can cause growth and fertility problems, delayed puberty, osteopenia, anemia, belly aches and bowel disturbances etc. Immunoglobulin deficiencies are also common and likely related to the autoimmune nature of such problems. Thyroid disease should also be evaluated with antibodies and thyroid function blood work. Many of us would also check adrenal and gastroparietal antibodies to make sure that there is no subtle adrenal insufficiency, other types of anemia etc. Often, the isolated IgA deficiency does not require treatment per se.

Additional comments from Dr. David Schwartz:

One of the better screening tests for celiac disease tests is for the presence of antibody proteins “attacking” certain other proteins of the body. There are several tests to consider but most involve the measurment of IgA antibodies. So, if your child is IgA deficient, then the screening for celiac disease may be FALSELY NORMAL thus FALSELY REASSURING: you can’t detect the presence of the marker for celiac disease issues if you can’t make the marker. Additional testing, including referral to a gastrointerologist, is the right ticket

By some accounts, IgA deficiency is very common, perhaps 1 in 400 people! Most of the time, IgA deficiency does not lead to serious health issues and does not warrant primary treatment.