Antigliadin Immunoglobulin A Best in Finding Celiac Disease in Children Younger Than 18 Months of Age

• DOI: 10.1097/mpg.0b013e31817d80f4
• Publication Date: 2008-10-10T07:09:00Z
• Authors: Carina Lagerqvist; Ingrid Dahlbom; Tony Hansson; Erik Jidell; Per Juto; Per Olcén; Hans Stenlund; Olle Hernell; Anneli Ivarsson
• Keywords: Male; Transglutaminases; Adolescent; Biopsy; Age Factors; Infant; Sensitivity and Specificity; Gliadin; Immunoglobulin A; 3. Good health; Diagnosis, Differential; Celiac Disease; 03 medical and health sciences; 0302 clinical medicine; Case-Control Studies; Child, Preschool; Intestine, Small; Humans; Female; Prospective Studies; Child; Biomarkers; Autoantibodies

ABSTRACTObjectives: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.Patients and 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.