No 2, 2010

Publication of the Month

 

 

February 02/10:

Antibodies in Celiac Patients Younger than 2 Years of Age

 

Maglio M, Tosco A, Paparo F et al.
Serum and intestinal celiac disease-associated antibodies in children with celiac disease younger than 2 years of age
J Pediatr Gastroenterol Nutr 2010, 50:43-48

Introduction
The classical serological test for the diagnosis of celiac disease is anti-tissue transglutaminase (anti-tTG) of the IgA isotype. The specificity and sensitivity of this test is so high that it was even suggested that diagnostic guidelines could be modified so that a small bowel biopsy is no longer regarded as mandatory in patients with very high transglutaminase antibody levels. However, in children younger than 2 years of age, it was shown earlier that anti-tTG has a lower sensitivity than anti-gliadin antibodies, which underlines the importance of gliadin antibody testing.

Patients and Methods
A total of 104 children younger than 2 years of age and 179 children older than 2 years, all of whom had been diagnosed with celiac disease, were investigaged for anti-gliadin IgA and IgG and anti-tTG IgA (all tests were provided by Eurospital, Italy).

Additionally, the presence of intestinal anti-tTG extracellular IgA depositis was looked for using double immunofluorescence.

Results

Celiac children

Anti-gliadin IgA

Anti-gliadin IgG

EMA

Anti-tTG IgA

Mucosal anti-tTG-IgA deposits

< 2 years old

89 %

94 %

88 %

87 %

73 %

> 2 years old

67 %

84 %

98 %

96 %

100 %

 

Conclusion
EMA and anti-tTG measurements show higher sensitivity for the diagnosis of CD in children older than 2 years compared to younger children. The search for mucosal deposits of anti-tTG-IgA does not improve the diagnostic performance.

Comment
Several publications showed that anti-tTG IgA are less sensitive in very young children than anti-gliadin antibodies (e.g. Lagerqvist et al, J Pediatr Gastroenterol Nutr 2008; 47:428-35). On the other hand, anti-gliadin antibodies are known to be much less specific and particularly in small children they may often occur transiently. A new generation of anti-gliadin antibody assays has been developed to detect antibodies to synthetic deamidated gliadin peptides, such as EliA GliadinDP. Our internal clinical study using samples of 122 children below 2 years of age with biopsy proven celiac disease showed that also EliA GliadinDP has a higher sensitivity than anti-tTG (EliA Celikey) in very young children:

n

Age

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

29

< 12 months

100 %

96.6 %

72.4 %

68

12-18 months

95.6 %

95.6 %

92.6 %

25

18-24 months

100 %

100 %

100 %

 

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As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.