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

Lagerqvist, Carina*; Dahlbom, Ingrid†,‡; Hansson, Tony; Jidell, Erik§; Juto, Per; Olcén, Per||; Stenlund, Hans**; Hernell, Olle*; Ivarsson, Anneli**

Journal of Pediatric Gastroenterology and Nutrition: October 2008 - Volume 47 - Issue 4 - p 428–435
doi: 10.1097/MPG.0b013e31817d80f4
Original Articles: Gastroenterology

Objectives: 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.

*Departments of Clinical Sciences, Pediatrics, Sweden

Clinical Microbiology, Virology, Sweden

**Public Health and Clinical Medicine, Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden

Women's and Children's Health, Sweden

Genetics and Pathology, Uppsala University, Uppsala, Sweden

§Transfusion Medicine, Umeå University Hospital, Umeå, Sweden

||Clinical Microbiology and Immunology, Örebro University Hospital, Örebro, Sweden

Received 20 December, 2007

Accepted 23 April, 2008

Address correspondence and reprint requests to Carina Lagerqvist, Clinical Laboratory Scientist, Department of Clinical Sciences, Pediatrics, Building 6M, 3rd Floor, S-901 85 Umeå, Sweden (e-mail:

Ms Lagerqvist and Ms Dahlbom contributed equally to this article.

Supported by Västerbotten County Council fund for research. All reagents for the antitissue transglutaminase and antigliadin antibody analyses were supplied by Phadia, Freiburg, Germany. The study received no monetary support from an entity with financial interests in the subject matter.

All of the authors fulfill the authorship criteria and none have affiliations with any organization or entity with a financial interest in the subject matter. The study was designed as a research project among the involved authors, each contributing with laboratory resources and expertise necessary for performing this large study. The final manuscript has been reviewed and approved by all of the authors and they have taken due care to ensure the integrity of the work.

The study was approved by the Research Ethical Committees of all Swedish Medical Faculties (§236/92, November 10, 1992; §267/03, May 13, 2003).

© 2008 Lippincott Williams & Wilkins, Inc.