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Simultaneous detection of IgA and IgG antibodies against tissue transglutaminase: The preferred pre-biopsy test in childhood celiac disease.
Scand J Clin Lab Invest. 2016; 76(3):208-16.SJ

Abstract

OBJECTIVES

IgA antibodies against tissue transglutaminase (anti-TG2) is a reliable marker of celiac disease (CD). However, IgA-deficient patients are not identified and young children may lack IgA anti-TG2. Combined detection of IgA and IgG (IgA/IgG) against deamidated gliadin peptides (DGP) has shown a high diagnostic performance for untreated CD. Here we examined the utility of IgA/IgG anti-TG2, IgA/IgG anti-DGP and IgA/IgG against a mix of TG2 and DGP (anti-TG2/DGP) in finding CD among children.

METHODS

Serum antibodies against TG2, DGP, and TG2/DGP were determined with ELISA in 242 children referred to a paediatric gastroenterologist. Fifty had untreated CD verified by an intestinal biopsy and 192/242 children had other diseases than CD.

RESULTS

Forty-eight untreated CD children had increased IgA/IgG anti-TG2, 47/50 had increased IgA/IgG anti-DGP and 46/50 had increased IgA/IgG anti-TG2/DGP. One control subject had increased IgA/IgG anti-TG2 and IgA/IgG anti-TG2/DGP, whereas 7/192 control subjects had increased IgA/IgG anti-DGP. The IgA/IgG anti-TG2 assay had the best performance with a sensitivity of 96%, a specificity of 99.5% and the area under the ROC-curve was 0.996 (95% CI 0.992-1, p < 0.0001).

CONCLUSIONS

Detection of one antibody is not sufficient when screening for untreated CD among children due to cases of IgA deficiency. The inclusion of DGP antigens in the IgA/IgG combination assays seems to affect the sensitivity and specificity negatively, whereas detection of IgA/IgG anti-TG2 has the potential of finding most untreated CD patients, including those with IgA deficiency.

Authors+Show Affiliations

a Departments of Women's and Children's Health , Uppsala University , Uppsala , Sweden ;a Departments of Women's and Children's Health , Uppsala University , Uppsala , Sweden ;a Departments of Women's and Children's Health , Uppsala University , Uppsala , Sweden ;a Departments of Women's and Children's Health , Uppsala University , Uppsala , Sweden ; b Departments of Immunology, Genetics and Pathology , Uppsala University , Uppsala , Sweden.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26924622

Citation

Dahlbom, Ingrid, et al. "Simultaneous Detection of IgA and IgG Antibodies Against Tissue Transglutaminase: the Preferred Pre-biopsy Test in Childhood Celiac Disease." Scandinavian Journal of Clinical and Laboratory Investigation, vol. 76, no. 3, 2016, pp. 208-16.
Dahlbom I, Nyberg BI, Berntson L, et al. Simultaneous detection of IgA and IgG antibodies against tissue transglutaminase: The preferred pre-biopsy test in childhood celiac disease. Scand J Clin Lab Invest. 2016;76(3):208-16.
Dahlbom, I., Nyberg, B. I., Berntson, L., & Hansson, T. (2016). Simultaneous detection of IgA and IgG antibodies against tissue transglutaminase: The preferred pre-biopsy test in childhood celiac disease. Scandinavian Journal of Clinical and Laboratory Investigation, 76(3), 208-16. https://doi.org/10.3109/00365513.2015.1137348
Dahlbom I, et al. Simultaneous Detection of IgA and IgG Antibodies Against Tissue Transglutaminase: the Preferred Pre-biopsy Test in Childhood Celiac Disease. Scand J Clin Lab Invest. 2016;76(3):208-16. PubMed PMID: 26924622.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Simultaneous detection of IgA and IgG antibodies against tissue transglutaminase: The preferred pre-biopsy test in childhood celiac disease. AU - Dahlbom,Ingrid, AU - Nyberg,Britt-Inger, AU - Berntson,Lillemor, AU - Hansson,Tony, Y1 - 2016/02/29/ PY - 2016/3/1/entrez PY - 2016/3/1/pubmed PY - 2016/12/15/medline KW - Celiac disease KW - autoantibodies KW - children KW - gliadin KW - tissue transglutaminase SP - 208 EP - 16 JF - Scandinavian journal of clinical and laboratory investigation JO - Scand. J. Clin. Lab. Invest. VL - 76 IS - 3 N2 - OBJECTIVES: IgA antibodies against tissue transglutaminase (anti-TG2) is a reliable marker of celiac disease (CD). However, IgA-deficient patients are not identified and young children may lack IgA anti-TG2. Combined detection of IgA and IgG (IgA/IgG) against deamidated gliadin peptides (DGP) has shown a high diagnostic performance for untreated CD. Here we examined the utility of IgA/IgG anti-TG2, IgA/IgG anti-DGP and IgA/IgG against a mix of TG2 and DGP (anti-TG2/DGP) in finding CD among children. METHODS: Serum antibodies against TG2, DGP, and TG2/DGP were determined with ELISA in 242 children referred to a paediatric gastroenterologist. Fifty had untreated CD verified by an intestinal biopsy and 192/242 children had other diseases than CD. RESULTS: Forty-eight untreated CD children had increased IgA/IgG anti-TG2, 47/50 had increased IgA/IgG anti-DGP and 46/50 had increased IgA/IgG anti-TG2/DGP. One control subject had increased IgA/IgG anti-TG2 and IgA/IgG anti-TG2/DGP, whereas 7/192 control subjects had increased IgA/IgG anti-DGP. The IgA/IgG anti-TG2 assay had the best performance with a sensitivity of 96%, a specificity of 99.5% and the area under the ROC-curve was 0.996 (95% CI 0.992-1, p < 0.0001). CONCLUSIONS: Detection of one antibody is not sufficient when screening for untreated CD among children due to cases of IgA deficiency. The inclusion of DGP antigens in the IgA/IgG combination assays seems to affect the sensitivity and specificity negatively, whereas detection of IgA/IgG anti-TG2 has the potential of finding most untreated CD patients, including those with IgA deficiency. SN - 1502-7686 UR - https://www.unboundmedicine.com/medline/citation/26924622/Simultaneous_detection_of_IgA_and_IgG_antibodies_against_tissue_transglutaminase:_The_preferred_pre_biopsy_test_in_childhood_celiac_disease_ L2 - http://www.tandfonline.com/doi/full/10.3109/00365513.2015.1137348 DB - PRIME DP - Unbound Medicine ER -