Two out of five Americans have gastrointestinal disorders: up to 20% are affected by IBS, 0.44% impacted by Crohn’s and ulcerative colitis, and up to 1% with celiac disease.
Accurate diagnosis of non-celiac gluten sensitivity (NCGS) and celiac disease is complex because both specific and nonspecific pathways of the immune system are involved.
The CICA evaluates a patient’s genetic risk for celiac disease, serum markers associated with active celiac disease process, and genetic serum markers associated with Crohn’s disease, and serological markers for diminished antigen exclusion in the gut.
Optionally, it can be combined with the Alcat Test to evaluate innate immune cell responses to foods and other substances for the most comprehensive assessment.
More than 95% of patients with celiac disease possess HLA-DQ2.5 and/or HLA-DQ8 genotype. More than 90% of those with celiac have the DQ2.5 genotype. Absent these markers, development of celiac is highly unlikely.
Crohn’s disease is triggered by a variety of environmental and genetic factors. It is described as a chronic inflammatory bowel disease (IBD) caused by a dysregulation of the immune response to intestinal flora and in parallel, accompanied by a defect of the epithelial barrier.
The predominant genetic markers are:
Tissue transglutaminase antibody (tTG) – IgA & IgG
In active celiac disease, damaged enterocytes produce tTG, therefore antibodies against tTG (IgA and/or IgG) are indicative of an active disease process. In patients with normal total IgA levels and negative tTG antibodies, the diagnosis of active celiac disease is unlikely. However, a certain percentage of patients with celiac disease may be seronegative. If tTG IgA is negative, while celiac disease is suspected, then additional markers included in this panel become more relevant in the diagnosis of gluten-related disorders.
Deaminated gliadin peptide (DGP) antibody - IgA & IgG
Deaminated gliadin can bind with tTG and become immunogenic. Therefore, detecting the presence of elevated IgA and/or IgG antibodies against DGP is an additional indicator of an active celiac disease process.
Anti-Saccharomyces Cerevisiae Antibody (ASCA)
ASCA is an indicator for the presence of Crohn’s disease. The presence of ASCA may also reflect increased intestinal inflammation and permeability, including that associated with active celiac disease.
Total Serum IgA
It is common for celiac disease patients to be IgA deficient. It is the most common immunologic deficiency (1:400-1:700 in the general population and 1:50 in celiac disease patients) and may be the single largest contributor to false negative results in biopsy confirmed celiac disease patients. Total Serum IgA is used as a measurement to qualify IgA testing for tissue transglutaminase (tTG) and deaminated gliadin peptide (DGP) antibody levels. When IgA levels are low or deficient, it is important to check IgG levels for both tTG and DGP (included in this array).
The Alcat Test for determination of cellular responses to foods and chemicals*
*When ordering any Alcat food panel together with the CICA, the lab fee of $75 can be waived from the total cost.
Are you currently on a gluten free or gluten restricted diet? Learn more
Because antibody titers are exposure related, purposeful avoidance of gluten can cause a decrease of serological results. Therefore, the patient’s exposure to gluten containing grains should be considered when interpreting tTg and DGP serology results.
Of the 4 celiac disease antibodies that are measured within the CICA, tTg-IgA is the most highly studied and most of our knowledge of the temporal relationship between the presence of antibody and the exposure to gluten come from that antibody. It is likely that the other antibodies have a similar pattern, but we cannot be certain.
For those in this category, who have been avoiding gluten for an extended period of time and who feel adverse reactions when gluten is consumed, a consultation with the health care provider regarding the re-introduction of gluten to the eating pattern prior to testing, is recommended. Perhaps another way to approach the issue of gluten avoidance prior to testing is to recommend testing in the individual’s current avoidance state. If the antibody results are positive then the avoidance did not have a significant effect. If the test is negative, then it is unknown whether the avoidance had an effect, so it might be helpful to retest after an interval of gluten exposure.
Leffler Daniel A., Schuppan D., et al Kinetics of the histologic, serologic and symptomatic responses to gluten challenge in adults with celiac disease. Gut. 2013 July; 62 (7): 996-1004. Celiac Center and Division of Gastroenterology, Beth Israel Deaconess Medical Center.
Option 1: Celiac, IBS, and Crohn’s Array (CICA)
(Genetic + Serologic)
Option 2: CICA – Genetic Only
Option 3: CICA – Serologic/Antibody Only
CICA test results are color-coded and easy to read. Each result is thoroughly explained with expert commentary.
Cell Science Systems Corp. is a specialty clinical laboratory that develops and performs testing in immunology, serology, cell biology and other specialties supporting the personalized treatment and prevention of chronic disease.
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Receive a package of information for this test including example results, research studies and more.
The CICA does not provide a diagnosis of celiac disease or any other symptoms. It is for informational purposes only and does not constitute medical advice or treatment in any way. If the test results indicate a strong celiac disease or Crohn’s disease susceptibility a thorough clinical evaluation should follow.