From the Guidelines
Elevated IgA levels require a thorough medical evaluation to determine the underlying cause, and treatment should target the specific condition, rather than the elevated IgA level itself. The most recent and highest quality study 1 provides guidance on the evaluation and management of conditions associated with elevated IgA levels. Common causes of elevated IgA include chronic infections, autoimmune disorders, liver diseases, certain cancers, and inflammatory bowel diseases.
Evaluation and Diagnosis
To determine the cause of elevated IgA levels, a healthcare provider may order additional tests, such as:
- Complete blood count
- Liver function tests
- Tissue biopsies, depending on symptoms
- Serum protein electrophoresis and quantification of immunoglobulin
- Beta2 microglobulin and albumin levels, which have prognostic impact 1
Treatment and Management
Treatment for elevated IgA levels targets the underlying condition, rather than the elevated level itself. For example:
- In cases of celiac disease, a gluten-free diet may be recommended 1
- In cases of Waldenström's macroglobulinaemia, treatment options may include PI-based therapy, bendamustine/rituximab, or ibrutinib 1
- In cases of peripheral neuropathy, evaluation of anti-myelin-associated glycoprotein, antigangliosides M1, and anti-sulfatide IgM antibodies may support the diagnosis of IgM-related neuropathy 1
Key Considerations
It is essential to note that elevated IgA levels can be associated with various conditions, and a thorough medical evaluation is necessary to determine the underlying cause. A healthcare provider should be consulted for proper evaluation and diagnosis, and treatment should be tailored to the specific condition. Additionally, regular monitoring and follow-up appointments may be necessary to manage the condition and prevent complications.
From the Research
Elevated IgA4 Levels
- Elevated IgA4 levels can be an indicator of various conditions, including IgG4-related disease, which is characterized by tumefactive lesions, increased serum IgG4 concentrations, and massive infiltration of IgG4-positive plasma cells 2
- However, mildly elevated serum IgG4 concentrations can also be seen in many other conditions, making diagnosis challenging
- Measuring serum concentrations of C-reactive protein and IgG subclasses can be helpful in diagnosis, as IL-6-mediated inflammation is an important driver of polyclonal hypergammaglobulinaemia in some cases 2
Related Conditions
- IgA nephropathy (IgAN) is a chronic glomerulonephritis characterized by the formation of immune complexes, including glycan-specific IgA1 or IgG antibodies, and is often associated with elevated IgA levels 3
- IgA vasculitis (IgAV) is a rare and poorly understood systemic vasculitis in adults, with a higher risk of evolving into end-stage renal disease 4
- Proteinuria is an independent predictor for IgAN progression, and measurements such as urine albumin-to-creatinine ratio (ACR) can be used to evaluate proteinuria and predict IgAN prognosis 5
Diagnostic Approaches
- Anatomopathological analysis of renal biopsies is essential for the diagnosis of IgAN, but noninvasive biomarkers such as proteomics and microRNAs are being developed as alternative diagnostic tools 3
- The complete blood count (CBC) is a frequently ordered laboratory test that can provide valuable information on various cell components, including red and white blood cell counts, and can aid in understanding the multiple uses of the CBC in difficult diagnoses and monitoring treatments for hematologic disorders 6