title: The old and new tests for celiac disease: which is the best test combination to diagnose celiac disease in pediatric patients?
abstract: 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.
  
  
  RESULTS
  Seventy-six of 95 (80%) CD patients were positive for DGP IgA and/or tTG IgA. Eighty of 95 (84.2%) patients were positive for DGP IgG and/or tTG IgA. None of the controls were positive for these antibodies. Eighty-four of 95 (88.4%) patients and 8/55 (14.5%) controls were positive for AAA and/or anti-tTG IgA.
  
  
  CONCLUSIONS
  In very young children, association of anti-tTG IgA with anti-DGP IgG is the best test combination for diagnosing CD, yielding a cumulative sensitivity of 84.2% and a specificity of 100%.
authors.affiliation: Department of Clinical Pathology "Buccheri La Ferla" Hospital, Palermo, Italy. ignbr@libero.it
authors.forename: Ignazio
authors.initials: I
authors.lastname: Brusca
authors.forename: Antonio
authors.initials: A
authors.lastname: Carroccio
authors.forename: Elio
authors.initials: E
authors.lastname: Tonutti
authors.forename: Danilo
authors.initials: D
authors.lastname: Villalta
authors.forename: Renato
authors.initials: R
authors.lastname: Tozzoli
authors.forename: Maria
authors.initials: M
authors.lastname: Barrale
authors.forename: Filippo M
authors.initials: FM
authors.lastname: Sarullo
authors.forename: Pasquale
authors.initials: P
authors.lastname: Mansueto
authors.forename: Stella Maria La
authors.initials: SM
authors.lastname: Chiusa
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iacono
authors.forename: Nicola
authors.initials: N
authors.lastname: Bizzaro
mesh_terms: D016022:Case-Control Studies; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis*; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000592:standards*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D007223:Infant; D008297:Male; D012015:Reference Standards; D012680:Sensitivity and Specificity