Antigliadin Immunoglobulin A Best in Finding Celiac Disease in Children Younger Than 18 Months of Age

Lagerqvist, Carina; Dahlbom, Ingrid; Hansson, Tomas; Jidell, Erik; Juto, Per; Olcén, Per; Stenlund, Hans; Hernell, Olle; Ivarsson, Anneli

doi:10.1097/mpg.0b013e31817d80f4

Cited by 77 publications

(74 citation statements)

References 31 publications

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“…IgA AGA is an obsolete test with low sensitivity and specificity; therefore, the search for these antibodies should be abandoned, except in very young children (under 2 years of age). 88 IgG tTGA should be used only for detecting CD in patients with IgA deficiency, a condition strictly related to CD. 89 A new antibody test has been introduced into the serological workup of CD.…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Celiac disease: diagnostic criteria in progress

2011

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Until a few years ago, celiac disease (CD) was thought to be a rare food intolerance that was confined to childhood and characterized by severe malabsorption and flat intestinal mucosa. Currently, CD is regarded as an autoimmune disorder that is common in the general population (affecting 1 in 100 individuals), with possible onset at any age and with many possible presentations. The identification of CD is challenging because it can begin not only with diarrhea and weight loss but also with atypical gastrointestinal (constipation and recurrent abdominal pain) and extra-intestinal symptoms (anemia, raised transaminases, osteoporosis, recurrent miscarriages, aphthous stomatitis and associated autoimmune disorders), or it could be completely symptomless. Over the last 20 years, the diagnostic accuracy of serology for CD has progressively increased with the development of highly reliable tests, such as the detection of IgA tissue transglutaminase and antiendomysial and IgG antideamidated gliadin peptide antibodies. The routine use of antibody markers has allowed researchers to discover a very high number of 'borderline' cases, characterized by positive serology and mild intestinal lesions or normal small intestine architecture, which can be classified as potential CD. Therefore, it is evident that the 'old celiac disease' with flat mucosa is only a part of the spectrum of CD. It is possible that serology could identify CD in its early stages, before the appearance of severe intestinal damage. In cases with a positive serology but with mild or absent intestinal lesions, the detection of HLA-DQ2 and HLA-DQ8 can help reinforce or exclude the diagnosis of gluten sensitivity.

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Section: Diagnostic Criteriamentioning

confidence: 99%

Celiac disease: diagnostic criteria in progress

2011

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“…However, discordant data between adults and children have been reported as the anti-tTG assay is less accurate in very young patients and autoantibody levels can fluctuate (9)(10)(11). In fact, the reported sensitivity for IgA anti-tTG, including all ages, ranges between 67% and 100%, with a specificity between 96% and 100% (5,(11)(12)(13)(14)(15)(16)(17)(18)(19), while in very young patients the sensitivity is lower, with a value ranging from 67% to 83% (11,17,18).…”

Section: Introductionmentioning

confidence: 98%

“…EMA sensitivity in children ranges from 83% to 100% (12,17,18,20), but is lower in children under 2 years of age, being approximately 85% (17,18,20).…”

Section: Introductionmentioning

confidence: 99%

The old and new tests for celiac disease: which is the best test combination to diagnose celiac disease in pediatric patients?

Brusca

Carroccio²,

Tonutti³

et al. 2012

Clinical Chemistry and Laboratory Medicine

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Background: In the diagnosis of celiac disease (CD), serum assays for anti-endomysium (EMA) and anti-transglutaminase (anti-tTG) antibodies have excellent diagnostic accuracy. However, these assays are less sensitive in young pediatric patients. Recently, a new ELISA test using deamidated gliadin peptides (DGP) as antigen has proved to be very sensitive and specific even in pediatric patients. In addition, anti-actin IgA antibodies (AAA) is another test that can be used in CD patients because antibody concentrations correlate with the degree of villous atrophy. This study evaluated the clinical accuracy of anti-tTG, EMA, AGA, anti-DGP and AAA and the effectiveness of these in different combinations for diagnosing CD in a large cohort of pediatric patients. Methods: Sera of 150 children under 6 years of age were tested: 95 patients had a diagnosis of CD, while 55 patients who did not suffer from CD were used as controls. Anti-DGP IgA/IgG and AAA were assayed with ELISA kits, while anti-tTG IgA/IgG and AGA IgG/IgA were assayed using a quantitative fluoroimmunoassay. The EMA test was conducted by indirect immunofluorescence.

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“…Because of possible reduced accuracy of IgA TTG for young children, some authors suggested adding antigliadin measurement for these patients [26,27]. The population study performed by Lagerqvist et al [28] showed that for children younger than 18 months, IgA AGA was more sensitive than IgA TTG and IgA EMA. On the basis of these results a combination of IgA AGA and IgA-TTG for identifying untreated CD in very young children was suggested as optimum [28].…”

Section: Discussionmentioning

confidence: 97%

“…The population study performed by Lagerqvist et al [28] showed that for children younger than 18 months, IgA AGA was more sensitive than IgA TTG and IgA EMA. On the basis of these results a combination of IgA AGA and IgA-TTG for identifying untreated CD in very young children was suggested as optimum [28]. Studies on the accuracy of DGP for this age group did not yield uniform results [9,29,30].…”

Section: Discussionmentioning

confidence: 98%