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. 1991 Aug;66(8):941–947. doi: 10.1136/adc.66.8.941

Antigliadin and antiendomysium antibody determination for coeliac disease.

A Bürgin-Wolff 1, H Gaze 1, F Hadziselimovic 1, H Huber 1, M J Lentze 1, D Nusslé 1, C Reymond-Berthet 1
PMCID: PMC1793455  PMID: 1819255

Abstract

The value of IgG and IgA gliadin antibodies (AGA) was compared with that of IgA endomysium antibodies (EMA) for the diagnosis of coeliac disease. Three hundred and six of 340 (90%) children with untreated coeliac disease (flat mucosa) had EMA and 338/340 (99.4%) had IgG AGA and/or IgA AGA. Only 1/340 (a 7 year old boy with selective IgA deficiency) had neither AGA nor EMA. Absence of EMA is more frequent in coeliac patients younger than 2 years than in older patients (32/277 compared with 1/62). EMA were present in 4/211 (2%) of comparison subjects (normal mucosa), IgA AGA in 12/211 (6%), and IgG AGA in 74/211 (35%). The specificity of AGA cannot be calculated from these figures as they are biased. The combined determination of AGA and EMA, taking advantage of the high sensitivity of AGA and the high specificity of EMA, gives an excellent prediction of the condition of the mucosa: 247/248 patients (99.6%) with positive EMA and positive IgG AGA and IgA AGA had a flat mucosa, whereas 136/137 patients (99.3%) with neither AGA nor EMA had a normal mucosa. During a gluten free diet EMA and AGA disappear. Their presence or absence is therefore an indicator of dietary compliance. After reintroduction of gluten into the diet 110/134 (82%) of the patients who had a flat mucosa at diagnosis relapsed, but 24/134 still had a normal mucosa after 2-15 years of challenge. All these patients without a morphological relapse were less than 2 years old at diagnosis so we conclude that patients who are young at diagnosis should be challenged. AGA often reappear earlier than EMA. After one month of challenge 93% of patients are AGA and 69% EMA positive. After more than three years of gluten intake the percentage of AGA positive patients decreased to about 50% whereas the percentage of EMA positive sera was then highest (93%). Therefore EMA are more sensitive for the detection of 'silent' relapse after prolonged periods of gluten intake.

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Selected References

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  1. Auricchio S., Greco L., Troncone R. Gluten-sensitive enteropathy in childhood. Pediatr Clin North Am. 1988 Feb;35(1):157–187. doi: 10.1016/s0031-3955(16)36405-7. [DOI] [PubMed] [Google Scholar]
  2. Begg C. B., Greenes R. A. Assessment of diagnostic tests when disease verification is subject to selection bias. Biometrics. 1983 Mar;39(1):207–215. [PubMed] [Google Scholar]
  3. Beutner E. H., Kumar V., Chorzelski T. P., Szaflarska-Czerwionka M. IgG endomysial antibodies in IgA-deficient patient with coeliac disease. Lancet. 1989 Jun 3;1(8649):1261–1262. doi: 10.1016/s0140-6736(89)92352-0. [DOI] [PubMed] [Google Scholar]
  4. Blazer S., Naveh Y., Berant M., Merzbach D., Sperber S. Serum IgG antibodies to gliadin in children with celiac disease as measured by an immunofluorescence method. J Pediatr Gastroenterol Nutr. 1984 Mar;3(2):205–209. doi: 10.1097/00005176-198403000-00006. [DOI] [PubMed] [Google Scholar]
  5. Burgin-Wolf A., Hernandez R., Just M. A rapid fluorescent solid-phase method for detecting antibodies against milk proteins and gliadin in different immunoglobulin classes. Experientia. 1972 Jan 15;28(1):119–120. doi: 10.1007/BF01928303. [DOI] [PubMed] [Google Scholar]
  6. Bürgin-Wolff A., Berger R., Gaze H., Huber H., Lentze M. J., Nusslé D. IgG, IgA and IgE gliadin antibody determinations as screening test for untreated coeliac disease in children, a multicentre study. Eur J Pediatr. 1989 Apr;148(6):496–502. doi: 10.1007/BF00441541. [DOI] [PubMed] [Google Scholar]
  7. Bürgin-Wolff A., Bertele R. M., Berger R., Gaze H., Harms H. K., Just M., Khanna S., Schürmann K., Signer E., Tomovic D. A reliable screening test for childhood celiac disease: fluorescent immunosorbent test for gliadin antibodies. A prospective multicenter study. J Pediatr. 1983 May;102(5):655–660. doi: 10.1016/s0022-3476(83)80229-7. [DOI] [PubMed] [Google Scholar]
  8. Bürgin-Wolff A., Hernandez R., Just M., Signer E. Immunofluorescent antibodies against gliadin: a screening test for coeliac disease. Helv Paediatr Acta. 1976 Dec;31(4-5):375–380. [PubMed] [Google Scholar]
  9. Chorzelski T. P., Beutner E. H., Sulej J., Tchorzewska H., Jablonska S., Kumar V., Kapuscinska A. IgA anti-endomysium antibody. A new immunological marker of dermatitis herpetiformis and coeliac disease. Br J Dermatol. 1984 Oct;111(4):395–402. doi: 10.1111/j.1365-2133.1984.tb06601.x. [DOI] [PubMed] [Google Scholar]
  10. Guandalini S., Ventura A., Ansaldi N., Giunta A. M., Greco L., Lazzari R., Mastella G., Rubino A. Diagnosis of coeliac disease: time for a change? Arch Dis Child. 1989 Sep;64(9):1320–1325. doi: 10.1136/adc.64.9.1320. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Juto P., Fredrikzon B., Hernell O. Gliadin-specific serum immunoglobulins A, E, G, and M in childhood: relation to small intestine mucosal morphology. J Pediatr Gastroenterol Nutr. 1985 Oct;4(5):723–729. doi: 10.1097/00005176-198510000-00007. [DOI] [PubMed] [Google Scholar]
  12. Kelly J., O'Farrelly C., Rees J. P., Feighery C., Weir D. G. Humoral response to alpha gliadin as serological screening test for coeliac disease. Arch Dis Child. 1987 May;62(5):469–473. doi: 10.1136/adc.62.5.469. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kieffer M. Serum antibodies to gliadin and other cereal proteins in patients with coeliac disease and dermatitis herpetiformis. Dan Med Bull. 1985 Oct;32(5):251–262. [PubMed] [Google Scholar]
  14. Koninckx C. R., Giliams J. P., Polanco I., Peña A. S. IgA antigliadin antibodies in celiac and inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 1984 Nov;3(5):676–682. doi: 10.1097/00005176-198411000-00006. [DOI] [PubMed] [Google Scholar]
  15. Kárpáti S., Bürgin-Wolff A., Krieg T., Meurer M., Stolz W., Braun-Falco O. Binding to human jejunum of serum IgA antibody from children with coeliac disease. Lancet. 1990 Dec 1;336(8727):1335–1338. doi: 10.1016/0140-6736(90)92893-m. [DOI] [PubMed] [Google Scholar]
  16. Malcolm S., Clayton-Smith J., Nichols M., Robb S., Webb T., Armour J. A., Jeffreys A. J., Pembrey M. E. Uniparental paternal disomy in Angelman's syndrome. Lancet. 1991 Mar 23;337(8743):694–697. doi: 10.1016/0140-6736(91)90278-w. [DOI] [PubMed] [Google Scholar]
  17. Mäki M., Lähdeaho M. L., Hällström O., Viander M., Visakorpi J. K. Postpubertal gluten challenge in coeliac disease. Arch Dis Child. 1989 Nov;64(11):1604–1607. doi: 10.1136/adc.64.11.1604. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Nicholls R. D., Knoll J. H., Butler M. G., Karam S., Lalande M. Genetic imprinting suggested by maternal heterodisomy in nondeletion Prader-Willi syndrome. Nature. 1989 Nov 16;342(6247):281–285. doi: 10.1038/342281a0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Rossi T. M., Kumar V., Lerner A., Heitlinger L. A., Tucker N., Fisher J. Relationship of endomysial antibodies to jejunal mucosal pathology: specificity towards both symptomatic and asymptomatic celiacs. J Pediatr Gastroenterol Nutr. 1988 Nov-Dec;7(6):858–863. doi: 10.1097/00005176-198811000-00011. [DOI] [PubMed] [Google Scholar]
  20. Scott H., Brandtzaeg P. Gluten IgA antibodies and coeliac disease. Lancet. 1989 Feb 18;1(8634):382–383. doi: 10.1016/s0140-6736(89)91753-4. [DOI] [PubMed] [Google Scholar]
  21. Scott H., Ek J., Brandtzaeg P. Changes of serum antibody activities to various dietary antigens related to gluten withdrawal or challenge in children with coeliac disease. Int Arch Allergy Appl Immunol. 1985;76(2):138–144. doi: 10.1159/000233680. [DOI] [PubMed] [Google Scholar]
  22. Scott H., Fausa O., Ek J., Brandtzaeg P. Immune response patterns in coeliac disease. Serum antibodies to dietary antigens measured by an enzyme linked immunosorbent assay (ELISA). Clin Exp Immunol. 1984 Jul;57(1):25–32. [PMC free article] [PubMed] [Google Scholar]
  23. Signer E., Bürgin-Wolff A., Berger R., Birbaumer A., Just M. Antibodies to gliadin as a screening test for coeliac disease. A prospective study. Helv Paediatr Acta. 1979 Feb;34(1):41–52. [PubMed] [Google Scholar]
  24. Stenhammar L., Kilander A. F., Nilsson L. A., Strömberg L., Tarkowski A. Serum gliadin antibodies for detection and control of childhood coeliac disease. Acta Paediatr Scand. 1984 Sep;73(5):657–663. doi: 10.1111/j.1651-2227.1984.tb09991.x. [DOI] [PubMed] [Google Scholar]
  25. Troncone R., Ferguson A. Anti-gliadin antibodies. J Pediatr Gastroenterol Nutr. 1991 Feb;12(2):150–158. doi: 10.1097/00005176-199102000-00002. [DOI] [PubMed] [Google Scholar]
  26. Troncone R., Pignata C., Farris E., Ciccimarra F. A solid-phase radioimmunoassay for IgG gliadin antibodies using 125I-labelled staphylococcal protein A. J Immunol Methods. 1983 Oct 14;63(2):163–170. doi: 10.1016/0022-1759(83)90421-0. [DOI] [PubMed] [Google Scholar]
  27. Volta U., Lenzi M., Lazzari R., Cassani F., Collina A., Bianchi F. B., Pisi E. Antibodies to gliadin detected by immunofluorescence and a micro-ELISA method: markers of active childhood and adult coeliac disease. Gut. 1985 Jul;26(7):667–671. doi: 10.1136/gut.26.7.667. [DOI] [PMC free article] [PubMed] [Google Scholar]

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