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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.. (2013) Selective measurement of anti-tTG antibodies in coeliac disease and IgA deficiency : an alternative pathway. Postgraduate Medical Journal, Volume 89 (Number 1047). pp. 4-7. ISSN 0032-5473

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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 > Health Sciences
Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016)
Faculty of Medicine > Warwick Medical School

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

Official Date:

August 2013

Dates:

Date	Event
August 2013	Published

Volume:

Volume 89

Number:

Number 1047

Page Range:

pp. 4-7

Identification Number:

10.1136/postgradmedj-2011-130188

Status:

Peer Reviewed

Publication Status:

Published

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