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IgA Deficiency Is Not Systematically Ruled Out in Patients Undergoing Celiac Disease Testing

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Abstract

Background

Guidelines for celiac disease (CD) testing recommend total serum IgA determination alongside anti-transglutaminase IgA antibodies. It is not well known if lack of serum IgA determination is a common finding in clinical practice.

Aim

To determine the prevalence of lack of serum IgA determination among patients screened for celiac disease.

Materials and Methods

We identified all subjects who underwent serum anti-transglutaminase IgA and/or other CD-related antibodies determination at a single teaching hospital in Buenos Aires from October 2019 to February 2020. Medical records were reviewed to select adult patients who were tested for celiac disease. The primary outcome was the proportion of patients with inadequate testing for celiac disease due to lack of serum IgA determination. We retrieved the following variables from each patient’s record: age, gender, body mass index, symptoms present at screening, first-grade family history of CD, history of type-1 diabetes mellitus, autoimmune hypothyroidism, Down’s syndrome.

Results

Overall, 1122 patients were included for analysis. Lack of serum IgA determination prevalence was 20.49%. Among patients who did have serum IgA determination, the prevalence of IgA deficiency was 5.16%. The following variables were independently associated with a significantly increased odds of serum IgA determination: diarrhea [OR 1.55 (1.01–2.34)] and abdominal pain [OR 2.28 (1.44–3.63)]; higher body mass index [OR 0.91 (0.85–0.98)], osteoporosis [OR 0.49 (0.28–0.89)], hypothyroidism [OR 0.18 (0.07–0.45)], arthralgia/arthritis [OR 0.47 (0.27–0.85)], or testing by endocrinologist [OR 0.46 (0.23–0.91)] and gynecologist [OR 0.14 (0.06–0.31)] were inversely associated.

Conclusion

IgA deficiency is not systematically ruled out in a relatively high proportion of patients undergoing serological screening of celiac disease.

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Authors and Affiliations

  1. Gastroenterology Department, Hospital Británico de Buenos Aires, Perdriel 74 (1012), Buenos Aires, Argentina

    Ezequiel Nazario, Juan Lasa, Belen Duarte, Diego Berardi, Silvina Paz & Ignacio Zubiaurre

  2. Biochemistry Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina

    Amalia Schill & Alexis Muryan

Authors
  1. Ezequiel Nazario
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  2. Juan Lasa
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  3. Amalia Schill
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  4. Belen Duarte
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  5. Diego Berardi
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  6. Silvina Paz
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  7. Alexis Muryan
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  8. Ignacio Zubiaurre
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Corresponding author

Correspondence to Juan Lasa.

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All authors declare no significant conflicts of interests.

Ethical standards and informed consent

We declare that all authors were committed to the ethical principles on clinical research detailed in the Declaration of Helsinki. The study protocol was reviewed and approved by our Institution’s Review Board. Since this was an observational retrospective study, there was no need for informed consent.

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Nazario, E., Lasa, J., Schill, A. et al. IgA Deficiency Is Not Systematically Ruled Out in Patients Undergoing Celiac Disease Testing. Dig Dis Sci 67, 1238–1243 (2022). https://doi.org/10.1007/s10620-021-06939-x

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  • DOI: https://doi.org/10.1007/s10620-021-06939-x

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