Tissue
Transglutaminase Antibody Assay (tTG)
Celiac disease and dermatitis herpetiformis, the two recognized forms
of gluten sensitive enteropathy (GSE) are characterized by chronic
inflammation on the intestinal mucosa and flattening of the epithelium
or positive “villous atrophy.” Intolerance to gluten, the
protein of wheat, rye and barley causes GSE. Patients with celiac disease
may suffer other diverse side effects or they may be asymptomatic.
Dermatitis herpetiformis is a skin disease associated with GSE. All
GSE patients have increased risk of lymphoma. A gluten-free diet
controls GSE and associated risks.
The development of serum tests for three different antibodies of the
IgA isotype made it possible to generate more rapid, revised European
Society for Pediatric Gastroenterology and Nutrition (ESPGAN) criteria
for celiac disease as reported in 1990. These tests include IgA endomysial
antibodies (EMA), IgA antigliadin antibodies (AGA) and R1 antireticulin
antibodies (ARA) The revised ESPGAN criteria call for:
a) a single positive gut biopsy and
b) the demonstration of at least two of the three
IgA class antibodies mentioned above. Since then, several studies
have demonstrated that IgA EMA tests have over 99% specificity for
GSE and a greater sensitivity than ARA or AGA tests.
Since the IgA EMA disappear when patients with celiac disease or dermatitis
herpetiformis adhere to a gluten-free diet, tests for these antibodies
also aid in checking on the adherence of patients to their diets. Recently,
the endomysial antigen has been identified as the protein cross-linking
enzyme known as tissue
transglutaminase (tTG).
Antigen specific ELISA procedures incorporating tTG afford a reliable,
objective alternative to the traditional immunofluorescent-based assays
incorporating thin sections of primate esophagus as substrate. The
assay for IgA antibodies to Tissue Transglutaminase (tTG) is a complementary
test to the Anti-Gliadin Antibody Assay. Both the Anti-Gliadin and
tTG Assays are aids in diagnosing celiac disease and other diseases
linked to celiac disease.The tTG assay should be ordered when either
Anti-Gliadin IgG, IgA or both are elevated. In instances where celiac
disease and its linked diseases are suspected both tests, the tTG and
Anti-Gliadin, could be requested simultaneously.
IgG
Delayed Food Allergy Assay
IgG
Delayed Food Allergy Assay
The majority of adverse immune reactions to foods classified as Type
II, III, or IV with delayed symptom onset, are mediated by IgG and
are termed food sensitivities. It has been estimated that 90%
of immune reactions to foods are non-IgE, or delayed symptom onset
food allergies.
A single blood test can identify food specific IgG antibodies
and thus identify patients’ food sensitivities. Recommended treatment
for food sensitivities is elimination of reactive foods from the diet
for a period of 3 to 4 months followed by reintroduction and rotation.
There are 115 foods tested in the Standard Panel Immuno 1 Bloodprint™.
Additional food panels include: vegetarian, kosher and pediatric.
The Assay, the Enzyme-Linked Immunoabsorbent Assay (ELISA) is designed
to detect circulating food specific immunoglobulin class G (IgG)
antibodies in serum. The procedure involves binding of FDA approved
allergenic extracts to polystyrene microtiter plate wells.When
serum is added to the wells, food specified IgG will bind to fixed
food allergen. Antihuman IgG-Horseradish Peroxidase conjugate is
then added to each well and incubated, followed by addition of
appropriate substrate. The resulting colored end product of the
enzymatic reaction is quantified spectrophotometrically. Positive
and negative controls as well as internal standards are included
on each microtiter plate.
Computer software adjusts absorbance readings for each sample well
and converts to a scoring scale for antibody levels: 0 (none detected),
1-4 (increasing levels of food specific IgG). A color enhanced
computer test report
lists all foods tested and provides a highlighted test score for
each positively reacting food. Immuno 1 Bloodprint™ Result
Formats Various food plan report formats are available, dependent
upon your patient’s needs or preferences, for the Immuno
1 Bloodprint™. Additionally, a small laminated card
listing IgG reactive foods is provided with these test results.
Candida
albicans Immunoassay
Candida
albicans Immunoassay A form of Candidiasis has emerged
which manifests symptoms that are often systemic and cause
considerable discomfort. It usually originates as an overgrowth
of the fungal form of Candida occurring in the lower gastrointestinal
tract. Frequent courses of steroid and antibiotic medications,
oral contraceptives and diet high in yeast-containing foods,
sugars, and refined carbohydrates are all known to encourage
Candida overgrowth. The ELISA test offers high sensitivity
and specificity in detecting early stage Polysystemic Chronic
Candidiasis (P.C.C.) thus allowing prompt initiation of therapy.
The Immunodiffusion test confirms late stage P.C.C. when
antibody levels have risen significantly. Both tests are
run on each patient sample. The Assay: comprises of two tests
designed to assist physicians in diagnosing P.C.C. The procedures
are:
1. Immunodiffusion: The Candida Immunodiffusion
test is an FDA approved procedure to detect precipitating
antibodies to both Candida cytoplasmic and mannan antigen
fractions.The test makes use of agarose gel to reveal bands
of precipitating antibodies (if present) in the patient’s
serum. Test results are reported as negative or positive;
if positive, the number of bands is reported.
2. Enzyme-Linked Immunoabsorbent Assay (ELISA):
uses the cytoplasmic protein of Candida albicans as the antigen
for detecting specific IgG. The results are indicated as
titers, 1:100 to greater than 1:5000. Titers 1:3000 and greater
are positive for P.C.C.
IgE
Airborne and/or Food Allergy Assay
IgE
Airborne and/or Food Allergy Assay
Some individuals experience immediate (Type I) allergy symptoms when
exposed to pollens, dust, animal dander and foods. Previously, skin
testing with its attendant patient risks and discomfort,was used to
diagnose these IgE mediated allergy reactions.
Recently, more convenient blood tests have been developed to detect
IgE specific for many allergens. Diagnosing specific allergies is the
first step in a program of patient health recovery, which can include
immunotherapy, lifestyle management and permanent elimination of reactive
foods. The assay detects serum IgE specific for airborne allergens
and foods. The procedure involves incubation of serum with airborne
and food allergenic extracts covalently bonded to a solid surface.
Specific IgE (if present in serum) binds to fixed allergen. Enzyme-labeled
antiserum to human IgE is added and incubated. A photoreagent substrate
is added and an enzymatic reaction produces luminiscence corresponding
to the reactive antigen. The luminiscence of each band is measured
using a luminometer. The degree of transmittance is directly proportional
to the allergic specific IgE. Antibody level is computer calculated
and expressed in classification units, which correlate with RAST
classes.
Anti-gliadin
Antibody Assay
Anti-gliadin
Antibody Assay
Over 100 chronic conditions, including celiac disease,have been associated
with increased levels of antigliadin
antibody (gliadin is the protein component of gluten). Since the 1970s,gluten-free
diets have
shown to be a reliable treatment in allowing celiac patients to return
to “normalcy.”
Recent research has shown the detection of anti-gliadin IgG and IgA
to be an indicator of gliadin
involvement in the medical condition.The Anti-gliadin Antibody Assay
(AGA) detects both IgG and IgA to
gliadin by the ELISA method.This test is a very effective screening
test for gliadin and is a good method for
monitoring patients’ adherence to a gluten-free diet.
Since the anti-gliadin antibody assay is a screening test, it must
be followed by the complementary test,
the Tissue Transglutaminase Assay, (tTG) in those patients who test
positive in the AGA.
Milk
and Egg Sub-Fractions
Why
test for sub-fractions? Many patients ask their physicians
if they can eat curd or whey protein, if they test positive
to milk. Sometimes they ask if they can have egg white or egg
yolk if they test positive for the whole egg. The answers can
be easily determined if the test for sub-fractions is performed.
One of the first steps in preparing cheese is to separate the
curds from the whey. This is often done by acid-precipitation
of the milk (souring), followed by centrifugation. Curds are
insoluble (precipitate); whey is liquid (supernate). Cheese
is made from curds. The major component of curds is Casein.
Whey proteins consist of Alpha-lactalbumin (ALA), Beta-lactoglobulin
(BLG), Bovine serum albumin (BSA) and lactoferrin (LF). These
five proteins, subfractions of milk, are tested individually.
If the patient is positive to Casein, they should not eat cheese.
If the patient is positive to any of the 4 proteins of whey,
they should not include whey proteins in their diet. The two
main components of egg are egg-white and egg-yolk. These two
sub-fractions of egg are tested separately. Most people
are positive to both. When positive to one sub-fraction and
negative to the other, the
negative component may be eaten. Sub-Fraction Test Components: Egg White, Egg Yolk, Alpha-lactalbumin, Beta-lactoglobulin,
Bovine serum albumin, Casein, and Lactoferrin
Comprehensive
Metabolic Panel-14
The
Comprehensive Metabolic Panel (CMP) is a frequently ordered group
of 14 tests that gives important information about the current status
of your kidneys, liver, and electrolyte and acid/base balance as
well as of your blood sugar and blood proteins. Abnormal results,
and especially combinations of abnormal results, can indicate a problem
that needs to be addressed.
Glucose (Diabetes)
Kidney (Renal)
Liver panel (Hepatic)
Electrolytes (*fasting required)
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(urine vs saliva), and some are unique. However, we wanted you to
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