Postgrad Med J 89:4-7 doi:10.1136/postgradmedj-2011-130188
  • Original article

Selective measurement of anti-tTG antibodies in coeliac disease and IgA deficiency: an alternative pathway

  1. Ramesh P Arasaradnam1
  1. 1Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, UK
  2. 2Department of Pathology, University Hospitals Coventry and Warwickshire, Coventry, UK
  1. Correspondence to Dr Ramesh P Arasaradnam, Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK; r.arasaradnam{at}
  1. Contributors EH, KKL & RPA, contributed to data analysis, drafting and preparation of manuscript. MP, contributed to data analysis. CN, DL & RPA, contributed to editing of manuscript for intellectual content.

  • Received 4 June 2011
  • Accepted 17 July 2012
  • Published Online First 7 August 2012


Objective To determine the ability of selective antibody testing to screen for coeliac disease in the presence of IgA deficiency and to define the sensitivity of a pathway using this method.

Method All IgA and IgG anti-tTG tests performed at our centre between January 2008 and December 2009, using the Immunocap 250 analyser, were retrospectively reviewed. Positive results were correlated with histology. Results were used to validate our diagnostic pathway.

Results 12 289 consecutive serological tests were reviewed. IgA deficient patients gave either an ‘error’ reading or very low response on the Immunocap 250 analyser. Subsequent testing of this sub-group demonstrated raised IgG anti-tTG antibodies in those with histologically proven coeliac disease.

Conclusions Using our antibody screening pathway, which involves the selective use of IgG anti-tTG, sensitivity increased from 87% to 92% in those with IgA deficiency. Adoption of this pathway for coeliac screening would negate the routine screening of immunoglobulin levels, with resultant cost saving.


  • Competing interests None.

  • Ethics approval Ethics approval was provided by an audit of current practice.

  • Provenance and peer review Not commissioned; externally peer reviewed.