Q:

4/27/2013
I have a 10 year-old Chinese girl with sudden onset of feeling full after eating a small meal since January 2013 without any cause. The bloating sensation lasts about 3-4 hours each time. She has no vomiting, nausea, or diarrhea. Her weight dropped from 72 lbs to 58 lbs since January. She had negative MR enterography last month. Celiac disease panel found slightly elevated Iga 297 mg/dl (ref: 62-236). She goes to school daily. She has figure skating practice 2-3 hours twice a week and runs one mile each week. Does this elevated Iga have any relationship to her bloating sensation after meal?

A:

Thank you for your recent inquiry.

Unfortunately I am not sure that I can be of any practical help to you in this regard. If one looks up a list of causes of elevated IgA, you see a total of 48 different diagnoses. They are divided into infections, neoplastic disorders, autoimmune disorders, neoplasms, congenital disorders, immune deficiencies (e.g., Wiskott-Aldrich, et cetera), poisonings (acute alcoholic hepatitis), and gastrointestinal diseases such as gluten enteropathy. However, none of these seem to fit your patient.

The most important thing that one can do is rule out monoclonality. To do this you could order an immunoelectrophoresis or an immunofixation. This would rule out any monoclonal elevation of IgA such as would occur in a malignancy.

I can only add an anecdotal comment in that it is not terribly unusual to see elevations of IgA of this magnitude without known cause.

Warm Regards
Phil Lieberman MD

AAAAI - American Academy of Allergy Asthma & Immunology