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Diagnostic Testing Algorithms for Celiac Disease



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Algorithm Breakdown

Slide 14

updated June 2011

The Serology Cascade is identical to the Comprehensive Cascade except that the HLA typing is not performed.  As far as the serology reflexing is concerned, the same pathways are followed as in the Comprehensive Cascade.

The IgA results are classified as normal, low, or deficient. For normal IgA, a TTG-IgA is performed. For positive and negative results, no further testing is required. If the TTG-IgA is equivocal, EMA and deamidated gliadin-IgA are performed, the results of which are included in the final report.

For individuals with selective IgA deficiency, testing for the IgG isotype for TTG and deamidated gliadin antibodies is performed followed by the release of the final report.  For a low IgA results, both isotypes for TTG and deamidated gliadin are performed followed by the interpretive report.

The main drawback of serology testing is the gluten-free diet, which can result in depressed antibody titers.  For this particular situation, we have developed the Gluten-Free Cascade.

Algorithm Breakdown

 


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