The options of celiac disease diagnostics in children with immunoglobulin A deficiency

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Introduction. Serological methods remain the main tool for screening for celiac disease. The most sensitive and specific markers of the disease are anti-tissue transglutaminase and anti-endomysium IgA antibodies, but the possibility of their use is limited by the concentration of serum total IgA. Due to the frequent association of celiac disease with selective immunoglobulin A deficiency, the search for diagnostic markers in this group of patients is relevant. Аim. Тo evaluate the diagnostic value of serological markers of celiac disease in children with decreased serum immunoglobulin A. Materials and methods. The sensitivity, specificity, positive and negative predictive value of IgG antibodies to anti-tissue transglutaminase (anti-tTG IgG), deamidated gliadin peptides (anti- DPG IgG) and gliadin (AGA IgG) were analyzed in a group of 166 children aged 1 to 17 years, average age 6.04 years, with varying degrees of immunoglobulin A deficiency. Results. The incidence of celiac disease in symptomatic patients with decreased serum immunoglobulin A concentrations was 13.2%, increasing up to 20% in the group of patients with selective IgA deficiency. Anti-tTG IgG demonstrated high values of sensitivity, specificity and positive predictive value as 85%, 97.3% and 85%, respectively. With comparable sensitivity and specificity, anti- DPG IgG were significantly worse with positive predictive value (26.7%). AGA IgG showed the lowest diagnostic value. When analyzing the dependence of the degree of histological changes on the concentration of tTG IgG, no statistically significant correlation was determined. Conclusions. Frequent association of gluten enteropathy with hypogammaglobulinemia A determines the need for active screening for celiac disease among children with these type of humoral immunity. Anti-tTG IgG demonstrate high diagnostic value in children with IgA deficiency, however, verification of the diagnosis of celiac disease in patients with hypogammaglobulinemia A requires mandatory endoscopic and histological studies.

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