Antigliadin immunoglobulin A best in finding celiac disease in children younger than 18 months of age.
OBJECTIVE
The aim was to investigate age-dependent serum levels and occurrence of elevated celiac disease (CD)-related antibodies in young children, to define the optimal serological procedure when selecting for small intestinal biopsy.


METHODS
Included were 428 children with biopsy verified CD (median age 16 months; range 7.5 months-14 years) and 216 controls (median age 2.7 years; range 8.5 months-14.6 years). Immunoglobulin (Ig) A antibodies against gliadin (AGA-IgA), tissue transglutaminase (tTG-IgA), and endomysium (EMA-IgA) were analysed.


RESULTS
Increased serum AGA-IgA levels were found in 411 of 428 CD cases, tTG-IgA in 385 of 428, and EMA-IgA in 383 of 428. In the control group, 11 of 216 had increased levels of AGA-IgA, 5 of 216 of tTG-IgA, and 8 of 216 of EMA-IgA. In CD children younger than 18 months, elevated AGA-IgA occurred in 97% and elevated tTG-IgA and EMA-IgA were found in 83% of the cases. Conversely, in CD children older than 18 months, elevated AGA-IgA occurred in 94%, and elevated tTG-IgA and EMA-IgA were found in 99% of the cases.


CONCLUSIONS
In children older than 18 months, both tTG-IgA and EMA-IgA are sufficiently accurate to be used as a single antibody marker, whereas a large proportion of younger children with CD lack these antibodies. Therefore, when selecting children for small intestinal biopsy, the detection of a combination of AGA-IgA and tTG-IgA is optimal for identifying untreated CD in children younger than 18 months.
Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden. carina.lagerqvist@pediatri.umu.se
Carina
C
Lagerqvist
Ingrid
I
Dahlbom
Tony
T
Hansson
Erik
E
Jidell
Per
P
Juto
Per
P
Olcén
Hans
H
Stenlund
Olle
O
Hernell
Anneli
A
Ivarsson
D000293:Adolescent; D000367:Age Factors; D001323:Autoantibodies / Q000032:analysis / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy / Q000379:methods; D016022:Case-Control Studies; D002446:Celiac Disease / Q000097:blood* / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005903:Gliadin / Q000032:analysis / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007223:Infant; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology*
D001323:Autoantibodies; D015415:Biomarkers; D007070:Immunoglobulin A; D005903:Gliadin; D011503:Transglutaminases