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Selective measurement of anti-tTG antibodies in coeliac disease and IgA deficiency : an alternative pathway
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Harrison, Elizabeth, Liu, Kuo-Kang, Petchey, Michael, Nwokolo, Chuka U., Loft, Duncan and Arasaradnam, Ramesh P.. (2012) Selective measurement of anti-tTG antibodies in coeliac disease and IgA deficiency : an alternative pathway. Postgraduate Medical Journal . ISSN 0032-5473 (In Press)
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Official URL: http://dx.doi.org/10.1136/postgradmedj-2011-130188
Abstract
Objective To determine the ability of selective antibody testing to screen for coeliac disease in the presence of IgA deficiency and to define the sensitivity of a pathway using this method (Figure1). Method All IgA and IgG anti-tTG tests performed at our centre between January 2008 and December 2009, using the Immunocap 250 analyser, were retrospectively reviewed. Positive results were correlated with histology. Results were used to validate our diagnostic pathway. Results 12,289 consecutive serological tests were reviewed. IgA deficient patients gave either an “error” reading or very low response on the Immunocap 250 analyser. Subsequent testing of this sub-group demonstrated raised IgG anti-tTG antibodies in those with histologically proven coeliac disease. Conclusions Using our antibody screening pathway, which involves the selective use of IgG antitTG, sensitivity increased from 87% to 92% in those with IgA deficiency. Adoption of this pathway for coeliac screening would negate the routine screening of immunoglobulin levels, with resultant cost saving.
| Item Type: | Journal Article |
|---|---|
| Subjects: | Q Science > QP Physiology R Medicine > RC Internal medicine |
| Divisions: | Faculty of Medicine > Warwick Medical School > Clinical Sciences Research Institute (CSRI) Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Metabolic and Vascular Health |
| Library of Congress Subject Headings (LCSH): | Celiac disease -- Diagnosis, Immunoglobulin A, Immunoglobulin G |
| Journal or Publication Title: | Postgraduate Medical Journal |
| Publisher: | BMJ |
| ISSN: | 0032-5473 |
| Date: | August 2012 |
| Identification Number: | 10.1136/postgradmedj-2011-130188 |
| Status: | Peer Reviewed |
| Publication Status: | In Press |
| Access rights to Published version: | Restricted or Subscription Access |
| References: | [1] Leeds JS, Hopper AD, Sanders DS. Coeliac Disease. Br Med Bull 2008;88(1):157-70. [2] NICE clinical guideline 86. Coeliac disease: recognition and assessment of coeliac disease. [3] Hill ID. What are the sensitivity and specificity of serologic tests for celiac disease? Do sensitivity and specificity vary in different populations? Gastroenterology. 2005;128(4 Suppl 1):S25-32. [4] McGowan KE, Lyon ME, Butzner JD. Celiac disease and IgA deficiency: complications of serological testing approaches encountered in the clinic. Clin Chem. 2008;54(7):1203-9 [5] Heneghan MA, Stevens FM, Cryan EM, et al. Celiac sprue and immunodeficiency states: a 25-year review. J Clin Gastroenterol 1997;25(2):421-5 [6] Thomas PD, Forbes A, Green J, et al. Guidelines for the investigation of chronic diarrhoea. 2nd edn. Gut 2003;52(Suppl 5):v1–v15 [7] Leffler DA, Schuppan D. Update on Serologic Testing in Celiac Disease. Am J Gastroenterol. 2010;105:2520–2524 [8] Korponay-Szabó IR, Dahlbom I, Laurila K, et al. Elevation of IgG antibodies against tissue transglutaminase as a diagnostic tool for coeliac disease in selective IgA deficiency. Gut. 2003;52(11):1567-71 [9] Lenhardt A, Plebani A, Marchetti Fet al. Role of human-tissue transglutaminase IgG and anti-gliadin IgG antibodies in the diagnosis of coeliac disease in patients with selective immunoglobulin A deficiency. Dig Liver Dis. 2004;36(11):730-4 [10] Fernandez E, Blanco C, Garcia S, et al. Use of low concentrations of human IgA anti-tissue transglutaminase to rule out selective IgA deficiency in patients with suspected coeliac disease. Clin Chem. 2005; 51(6):1014-1016 [11] Löwbeer C, Wallinder H. Undetectable anti-tissue transglutaminase IgA antibody measured with ELISAA Celikey indicates selective IgA deficiency. Clin Chim Acta. 2010;411(7-8):612 |
| URI: | http://wrap.warwick.ac.uk/id/eprint/50135 |
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