New advances for serologic evaluation of celiac disease and dermatitis herpetiformis

Abstract

The tTG ELISA shows comparable performance to the more traditional IgA endomysial antibody test using immunofluoresence and primate esophagus sections. The tTG ELISA has the advantage of being objective and is not adversely influenced by the presence of interfering antibodies such as antinuclear (ANA) and smooth muscle antibodies (ASMA). The test can be used to economically screen large numbers of symptomatic as well as asymptomatic but at risk individuals. The ELISA methodology will afford an opportunity to better standardize celiac serologies from laboratory to laboratory since the performance of the current endomysial test is highly dependent on the microscope used, the initial screening dilution, the fluorescein to protein (f/p) ratio of the anti IgA conjugate, and the microscopist interpreting the test. Another potential problem with the current immunofluorescent based endomysial test is the increasing scarcity of fresh, healthy primate tissue for producing the substrate slides. We envision the tTG ELISA as being an integral part of a serological work up for suspected celiac and dermatitis herpetiformis patients. The inclusion of tTG ELISA along with tests for gliadin IgA and IgG antibodies can provide a sensitive, specific and objective assessment of individuals to be considered for confirmatory biopsy or even a trial with gluten-free diet.