Mucosal and systemic IgA anti-gliadin antibody in celiac disease

Abstract

Serum IgA anti-gliadin antibody estimation is a recognized screening method for celiac disease. However, celiac disease is primarily a small intestinal mucosal disorder, and so we have examined the possibility that secreted, mucosal IgA anti-gliadin antibody might provide a more relevant measure of gluten sensitivity than that obtained from serum tests. Serum IgA anti-gliadin antibody and serum, salivary, and small intestinal aspirate IgA anti-gliadin antibody were measured by enzyme-linked immunosorbent assay. Serum IgA and IgG anti-gliadin antibody were markedly increased in untreated celiacs (N = 31) as compared to normals (N = 20) or disease controls (N = 39) (P less than 0.0001). Levels were lower in treated (N = 30) than untreated celiacs (P less than 0.001). In intestinal aspirates both untreated and treated patients had similar levels of IgA anti-gliadin antibody (P = 0.48), but both were significantly higher than in controls (P less than 0.01). Salivary IgA anti-gliadin antibody, by contrast, was not increased in celiac patients as compared to controls. Serum IgA anti-gliadin antibody was the most sensitive (84%) and specific (95%) test for detecting untreated celiac disease. It was also the most useful in patient follow-up where it provides an early objective indicator of adherence to a gluten-free diet. Mucosal IgA responses to gliadin in celiac disease appear to be compartmentalized, with different portions of the gastrointestinal tract functioning as separate immunological organs. Our results also demonstrate that serum and secretory IgA production are under independent control.

Salivary Antigliadin and Antiendomysium Antibodies in Coeliac Disease

“…Based on clinical studies Al-Bayaty et al [7] and Hakeem et al [8] suggested that salivary AGA can be used to detect CD in children and adults. This conclusion was not confirmed by Kelly et al and Patinen et al [11,12], who did not find elevated IgA AGA levels in saliva, despite elevated levels in serum. Kelly et al [11] also examined the AGA levels in gastrointestinal secretions and found them to be elevated.…”

“…This conclusion was not confirmed by Kelly et al and Patinen et al [11,12], who did not find elevated IgA AGA levels in saliva, despite elevated levels in serum. Kelly et al [11] also examined the AGA levels in gastrointestinal secretions and found them to be elevated. The present results showed no correlation between serum and salivary IgA or IgG AGA values at the individual level.…”

“…Some authors suggest that the IgA AGA levels in the saliva of untreated CD patients are sufficiently high to be used as a noninvasive screening test for CD and for following the compliance of the patient on a gluten-free diet [7][8][9]. However, there are also studies that do not confirm an association between serum and salivary IgA AGA in patients with CD [10,11] and dermatitis herpetiformis [12]. This implies that the production of systemic and salivary IgA AGA is controlled separately [9,10].…”

A Case of Celiac Disease Presenting with Recurrent Attacks of Quadriparesis

“…IgA tissue transglutaminase antibodies has a sensitivity of 90 to 98 percent and a specificity of 95 to 97 percent. 10 Nonetheless, a positive antibody test suggests that a person might have celiac disease, but to confirm, a biopsy will be needed. 11 Peripheral neuropathies maybe found in up to 50 percent of patients with celiac disease and may precede its diagnosis.…”

Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on ‘Nutrition and autoimmune disease’

“…Measuring anti-gliadin antibodies in serum was used as an adjunct to biopsy and, although useful, the test lacks specificity and is only moderately sensitive (6,7) . An assay for the detection of anti-endomysial antibodies was reported in the early 1980s (8) and deployment of this test became widespread in the following decade.…”