Are Immunoglobulin A Anti‐gliadin Antibodies Helpful in Diagnosing Coeliac Disease in Children Younger Than 2 Years?

Abstract

The usefulness of immumoglobulin (Ig) A antibodies to gliadin (AGA-IgA) in addition to IgA anti-endomysium and tissue transglutaminase antibodies was evaluated in 4122 children younger than 2 years with a suspicion of coeliac disease (CD). Eight percent (312/4122) displayed IgA anti-endomysium and/or IgA anti-tissue transglutaminase, whereas 2.1% (85/4122) displayed only AGA-IgA. Clinical data were obtained for 62 of 85 children with isolated AGA-IgA, and 33 children underwent a duodenal biopsy. Histologically proven CD was established for 5 patients, whereas 57 children were diagnosed to experience other diseases. The systematic detection of AGA-IgA using native gliadin conferred no additional diagnostic benefit for the diagnosis of CD in children younger than 2 years of age, except for rare cases.

Celiac disease diagnosis: Impact of guidelines on medical prescription in France

“…Anti‐endomysium antibody is also considered to be a good serological marker for celiac disease, despite the operator‐dependent test results. Currently, anti‐gliadin antibody is no longer considered to be a sensitive or specific marker for celiac disease . Moreover, the use of deamidated gliadin peptides to improve the characteristics of anti‐gliadin antibody detection by new‐generation tests needs to be further evaluated, although recent reports provide no evidence of their improved accuracy .…”

“…Currently, antigliadin antibody is no longer considered to be a sensitive or specific marker for celiac disease. 24,25 Moreover, the use of deamidated gliadin peptides to improve the characteristics of anti-gliadin antibody detection by new-generation tests needs to be further evaluated, although recent reports provide no evidence of their improved accuracy. 24,26,27 In the same way, anti-reticulin antibody no longer has a place in the serological strategy for celiac disease diagnosis, and French guidelines have even recommended abandoning this marker.…”

Diagnosis of Coeliac Disease in Children Younger Than 2 Years

“…Unfortunately, at the beginning of our study, we could not determine either anti-TG2 or deamidated forms of gliadin peptides. Instead, we used AGA, and there is some evidence that its sensitivity may be higher in children younger than 2 years in comparison with EMA and anti-TG2 tests (1,29,37); however, the new guidelines stated that the specificity of AGA tests is extremely low in this age group, making it not helpful for clinical practice (1,38,39). In our study, the sensitivity of AGA IgA was 92% and of AGA IgG 100%, whereas the specificity was extremely low (AGA IgA 59% and AGA IgG 36%).…”

Assessing of Celiac Disease and Nonceliac Gluten Sensitivity

“…Although it has been reported that IgA-AGAs perform better than IgA anti-tissue transglutaminase 2 antibodies (IgA-tTG) and IgA anti-endomysium antibodies (IgA-EMA) in children younger than 18 months of age [ 70 ], a recent study showed only 5 out of 33 patients under 2 years of age with positive IgA-AGAs levels were confirmed histologically to have CD [ 71 ]. To avoid false negative results, some authors recommend endoscopy with small bowel biopsies to perform CD diagnosis in IgA-AGA positive individuals [ 72 ].…”