First salivary screening of celiac disease by detection of anti-transglutaminase autoantibody radioimmunoassay in 5000 Italian primary schoolchildren.
OBJECTIVE
The high prevalence of celiac disease (CD) prompted us to evaluate a new, noninvasive disease screening strategy. The aim was to identify CD in 6- to 8-year-old children for a timely diagnosis, start gluten-free diet (GFD) in compliant subjects, achieve the growth target, and prevent CD complications.


METHODS
Five thousand subjects were invited to participate in the study. Four thousand forty-eight saliva samples were tested for anti-tissue transglutaminase (tTG) immunoglobulin (Ig)A using a fluid-phase radioimmunoprecipitation method. Positive children were tested for serum radioimmunoassay tTG IgA, enzyme-linked immunosorbent assay tTG IgA, and anti-endomysium IgA. Children confirmed as positive by serum assays underwent endoscopy with duodenal biopsies and, at the diagnosis of CD, were suggested to start GFD.


RESULTS
Consent was obtained from 4242 parents (84.8%) for the screening to be performed, and adequate saliva samples were collected from 4048 children (95.4%). Thirty-two children were found to be salivary tTG IgA positive and 9 with borderline autoantibody levels. Thirty-one of the 32 and 3 of the 9 subjects were also serum positive. Twenty-eight children showed villous atrophy when undergoing intestinal biopsy, whereas 1 had Marsh 1 lesions; 3 children were suggested to start GFD without performing endoscopy. CD prevalence in the population investigated (including 19 CD known cases) was 1.16%. The ratio between screening-detected patients and those diagnosed before the screening was 3:2. The ratio between symptomatic and asymptomatic patients was 1:1.6.


CONCLUSIONS
We demonstrated that it is possible to perform a powerful, simple, well-accepted, and sensitive CD screening using saliva. Until now, the compliance with GFD in children with CD has been optimal.
Departments of Paediatrics, La Sapienza University of Rome, Italy. margherita.bonamico@uniroma1.it
Margherita
M
Bonamico
Raffaella
R
Nenna
Monica
M
Montuori
Rita Pia Lara
RP
Luparia
Arianna
A
Turchetti
Maurizio
M
Mennini
Federica
F
Lucantoni
Donata
D
Masotti
Fabio Massimo
FM
Magliocca
Franco
F
Culasso
Claudio
C
Tiberti
D001323:Autoantibodies / Q000032:analysis* / Q000097:blood; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000453:epidemiology; D002648:Child; D055050:Diet, Gluten-Free; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis* / Q000097:blood; D007558:Italy / Q000453:epidemiology; D016014:Linear Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010349:Patient Compliance; D010865:Pilot Projects; D015995:Prevalence; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011863:Radioimmunoassay; D012463:Saliva / Q000737:chemistry*; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology*
D001323:Autoantibodies; D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins