I'm not IgA deficient, so why are my EnteroLab scores low?

patc73 · Post by **patc73** » Tue Jul 24, 2012 12:21 pm

When I had the EnteroLab Gluten/Antigenic Food Sensitivity stool panel done last year, my scores were: Anti-gliadin IgA 7 units, Anti-casein IgA 8, Anti-ovalbumin 6, and Anti-soy 5. The results stated that I may be IgA deficient, but I finally had a blood test recently, and that's not the case. The EnteroLab results go on to state, "rarely, some immunocompetent people can still have clinically significant reactions to a food antigen despite the lack of a significant antibody reaction (because the reactions primarily involve T cells)". So I guess I fall into that group, because I definitely react to gluten, casein, and soy, and sometimes also to eggs. So what now? Are my intolerances all because of T cells, then? Is that the same as saying that mast cells, or histamine, cause all of my food intolerances? Should I be taking an antihistamine? Tex...help!

Pat

Post by **tex** » Tue Jul 24, 2012 4:57 pm

Hi Pat,

These are uncharted waters, so we can only guess at what might be going on. Yes, it's possible to have inflammation without antibodies (this is true with celiac disease, also), and on the other hand, it's also possible to produce antibodies without T cell infiltration into the epithelia.

Research data are sparse regarding the generation of excess numbers of T cells in the absence of antibodies, but there is a good chance that it may be in response to inappropriate mast cell degranulation (MCAD), so taking antihistamines may be worth a try. The problem might be due to excess histamine, or it could be due to cytokines or other inflammatory modulators.

Are you taking a corticosteroid? Corticosteroids suppress mast cell numbers, but it's still possible to have excess histamine in circulation, due to a diamine oxidase (DAO) deficiency which would allow a residual histamine buildup. Avoiding foods that have a high histamine content, and foods that trigger the release of histamines, might be helpful (at least on a trial basis).

http://www.michiganallergy.com/food_and_histamine.shtml

Tex

patc73 · Post by **patc73** » Tue Jul 24, 2012 6:50 pm

Thanks, Tex! No, I'm not taking a corticosteroid, just sulfasalazine and cholestyramine resin. Benadryl seems to help with a light rash I get on my face with some foods, so I take that at bedtime some nights. Maybe I'll take it every night! I have been trying to follow the low histamine diet, but it's hard to avoid bananas, tomatoes, avocadoes, and citrus...I'll just have to try harder. I'm just now getting over a six-week flare that started with soy sauce (Bragg's Liquid Aminos) and fried eggs, so those are definitely off the list of tolerable foods. A GF coconut and chocolate cookie made me worse. I wish more doctors could be knowledgeable about CC and it's causes, because mentioning my histamine problems to my PCP and rheumatologist gets me nowhere. (My PCP told me I shouldn't take Benadryl every night.) I've been allergic to molds, pollen, dry leaves, etc. my whole life, so I imagine I've had mast cell degranulation forever, too. If we could treat kids with MCAD, maybe they wouldn't end up as adults with MC!

Pat

Post by **tex** » Tue Jul 24, 2012 10:20 pm

Pat,

If I remember correctly, taking Benadryl regularly can lead to a tolerance for it, resulting in lowered effectiveness (or a need for a higher dose). Because of that risk, it's best to alternate antihistamines from time to time.

I'm in the same boat as you on the molds, pollen and leaves. They've been a life-long problem for me too.

Tex

Deanna in CO · Post by **Deanna in CO** » Wed Jul 25, 2012 8:59 am

Hi Pat,

Just wondering, too, how long you've been off gluten, dairy, soy, and egg? Because once you get those out of your diet, the level of antibodies you produce against them begins to drop. The half-life for gluten is longest, and it can take a couple of years to get rid of that completely (I can't remember, but it seems to me you had been off gluten for a long time when you joined this group - or am I thinking of someone else?). The others have much shorter half-lives and the levels in your stool can drop reasonably quickly, and if your levels were already on the lower side, they might drop low enough that you don't show antibodies (even though your body would start producing them again in a heartbeat if you started eating them again).

In my case, I went off gluten in November, dairy in December, and egg and soy in February. When I did the Enterolab tests in May, my gluten was 34, my casein was 32, my albumin was 11, and my soy was 5. I believe, based on my reading and experience, that all these had been significantly higher before I went off them. I had eaten a lot of eggs, up until February (for breakfast almost every day), and I don't react quite as strongly to them as I do to dairy, so my antibodies to them dropped quickly. After I went on a much healthier eating plan in November, I had not eaten much soy (except some pure, GF soy sauce from time to time), so my antibodies to soy dropped even faster. But I seem to react pretty strongly to even a small amount of soy, in spite of my test results.

So here's my take: I think Enterolab's results are much more helpful if you do them before you make significant dietary changes. Once you've made the changes, especially if you've been off something for a number of months (a couple of years in the case of gluten), their main usefulness is to tell you whether you are getting cross-contamination. (So if I have the tests done again in a couple of years, and still have elevated levels for gluten and casein, I'll know I'm getting cross-contaminated; your results tell you that you are not getting much if any cross-contamination, and that's a good thing.)

Does that make sense?

patc73 · Post by **patc73** » Wed Jul 25, 2012 9:50 am

Yes, that makes sense, Deanna! I joined the forum the day I was diagnosed (May 18, 2011), and had the Enterolab tests done in June, so just a month after changing my diet. I had only cut out gluten and dairy, but not soy or eggs, until a couple of months later. Lately, my problems have stemmed from cheating a little on the soy and eggs, and some cross-contamination due to having gluten in our kitchen, and eating too many raw fruits and veggies. Fiber seems to mess me up quickly unless I've been having normans for a while. Today it's been almost-normans, then soft serve, then watery D, all within an hour. So I guess my flare isn't over yet!

Leah · Post by **Leah** » Wed Jul 25, 2012 6:01 pm

Pat, I don't mean to question your IgA test, but there were a couple of people here that thought their IgA level was tested, but it wasn't. Instead, they ordered the IgA/Celiac test. It happened to my own daughter, so we still don't know about her. Just a thought. What was the test called?

Leah

MBombardier · Post by **MBombardier** » Wed Jul 25, 2012 6:09 pm

My enterolab tests were a bust, too. Gluten was highest at 5 units, and dairy, soy, egg, and yeast were all 1 unit. When my IgA was tested, it was normal. The thing that was really abnormal was the fecal fat score--almost off the chart, showing severe gluten-induced small intestine damage.

The more I learn, the more I think that my problems are caused by mast cells. I have been plagued with seasonal allergies and random food allergies most of my life, not to mention my current decoration with granuloma annulare that flares when I eat certain foods.

patc73 · Post by **patc73** » Thu Jul 26, 2012 9:14 am

Leah, I specifically asked for an IgA deficiency blood test, separate from the celiac test (which was, of course, negative). They said it showed normal IgA levels.
Marliss, I'm glad I'm not alone in this! I didn't have the fecal fat score done, but I know for sure it is (or was) very high, because fat (and mucus) have been visible in the stools! I hate to self-treat for a disease this serious, but doctors don't seem to understand mast cell involvement in MC at all! What meds do you take?

Pat

MBombardier · Post by **MBombardier** » Thu Jul 26, 2012 10:48 am

I take a Zyrtec in the mornings because I ran out of Allegra. I think they work about the same for me, and the Zyrtec is cheaper. I buy the generic at Costco, which is about $15 for 360 tablets. After I go out in the garden (or eat cashews) and my granuloma annulare goes nuts, I take Benedryl. I don't take Zantac because it acted on my stomach like a PPI. I really enjoy not having heartburn, which I used to have all the time, and I don't want to worry about my stomach rebounding from it. I would probably do better if I did take Zantac, but that's the way I feel.

Other than that, I don't do meds. I try to stay away from high-histamine foods like dried fruit and processed meats, but I eat fresh foods like avocado and apples. I seem to do okay with them.

patc73 · Post by **patc73** » Thu Jul 26, 2012 10:52 am

Marliss, can you eat tomatoes or bananas?

MBombardier · Post by **MBombardier** » Thu Jul 26, 2012 1:49 pm

Bananas, no problem, and I eat them to help with magnesium/potassium.

Tomatoes I can eat a little now. I used to get horrible eczema literally on my lips and through my alimentary canal, and my knees would get sore and swollen. Now I can eat tomatoes in guacamole, for example, and I have even eaten spaghetti sauce with no consequences. I can also eat green chilies and onions in the guacamole with no consequences, so that's an improvement, too.

But my allergies are so random. I can't know from time to time if I can eat tomatoes, bananas, watermelon, cantaloupe, cherries, apples, or almonds. I have reacted allergically from time to time to all of them. Sometime I'd just like to eat something without assessing my reaction to it, you know?

Leah · Post by **Leah** » Thu Jul 26, 2012 8:35 pm

I know!!!!!!!!!!!!!!

patc73 · Post by **patc73** » Fri Jul 27, 2012 7:15 am

That's so true! I get "oral allergy syndrome", where my lips, cheeks, tongue, palate, and the tip of my nose go numb, after eating certain foods, but only sometimes!