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It has been our practice to perform immunoglobulin (Ig)A anti-tissue transglutaminase (tTG), IgA/IgG antiendomysial (EMA) and IgA/IgG antigliadin (AGA) antibody tests for children under 3 years of age being investigated for coeliac disease. This was based on data showing that EMA may be negative in children. In a study of 277 children under 2 years of age who had biopsy-proven untreated coeliac disease, 88% were EMA positive, 100% were IgG-AGA positive, and 84% were IgA-AGA positive. Eleven per cent of patients were positive for AGA only (though 25% of these were positive for IgG-AGA only).1 The overall AGA specificity is poor, especially that of IgG-AGA.2 Importantly, over a third of AGA-positive young children became spontaneously negative over the following 3 years.3
Data on using AGA alongside recombinant human tTG-based tests are limited and study sizes are small. Equivalent sensitivity of tTG and EMA has been shown with AGA in …
Competing interests: None.