Clinical Chemistry
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Clinical Chemistry 55: 150-157, 2009. First published November 6, 2008; 10.1373/clinchem.2008.110395
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(Clinical Chemistry. 2009;55:150-157.)
© 2009 American Association for Clinical Chemistry, Inc.

Pediatric Clinical Chemistry

Antibodies against Synthetic Deamidated Gliadin Peptides for Celiac Disease Diagnosis and Follow-Up in Children

Daniela Basso1, Graziella Guariso2, Paola Fogar3, Alessandra Meneghel2, Carlo-Federico Zambon3, Filippo Navaglia1, Eliana Greco4, Stefania Schiavon4, Massimo Rugge4 and Mario Plebani1,4,a

1 Department of Laboratory Medicine, University of Padova; 2 Department of Pediatrics, University of Padova; 3 Department of Medical and Surgical Sciences, University of Padova; 4 Department of Medical Diagnostic Sciences and Special Therapies, University of Padova, Italy.

aAddress correspondence to this author at: Department of Laboratory Medicine, University-Hospital of Padova, Via Giustiniani 2, 35128 Padova, Italy. Fax +39049663240; e-mail mario.plebani{at}unipd.it.

Background: AGA IgA II and AGA IgG II have recently been suggested as reliable tools for celiac disease (CD) diagnosis. We compared their utility for diagnosis and monitoring CD in children with that of tTG IgA, an established CD marker.

Methods: We studied a cohort of 161 CD and 129 control children in whom CD was histologically confirmed or ruled out. We followed 37 children with CD on a gluten-free diet for 12–84 months. In fasting sera, we measured AGA IgA II, AGA IgG II, and tTG IgA using ELISAs.

Results: The best sensitivity (92.5%), specificity (97.6%), positive predictive value (98%), and negative predictive value (91.2%) were obtained using tTG IgA. AGA IgG II correctly identified 3 of 3 children with CD with total IgA deficiency who had negative AGA IgA II and tTG IgA results. In children <2 years old without total IgA deficiency, AGA IgG II and tTG IgA performed equally well (sensitivity 96.4% and specificity 100%). AGA IgA II, AGA IgG II, and tTG IgA concentrations diminished significantly (P < 0.0001) after 1 year of a gluten-free diet, reaching values below the cutoff in 87%, 70%, and 51% of cases, respectively.

Conclusions: The best available index for diagnosing CD in children was tTG IgA. In infants <2 years old, AGA IgG II performed as well as tTG IgA in cases without total IgA deficiency and allowed detection of CD when total IgA was <0.06 g/L. Gluten-free diet monitoring can be achieved using any of the studied serum markers.






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