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    Celiac Disease Blood Antibody Tests

    Reviewed and edited by a celiac disease expert.

    Just how reliable are blood antibody tests for screening celiac disease?

    Celiac Disease Blood Antibody Tests - Celiac disease blood tests are very accurate. Image: CC BY 2.0--tuckerives
    Caption: Celiac disease blood tests are very accurate. Image: CC BY 2.0--tuckerives

    Celiac.com 02/05/2023 - If you have celiac disease symptoms, for example chronic diarrhea, anemia, bloating, abdominal pain, rashes, are in a higher risk group, etc., your doctor may order a blood test for celiac disease. Note that before doing any blood tests for celiac disease you must be eating gluten for a while beforehand, and the amount and length of time can vary, but is somewhere between 2 slices of wheat bread daily for 6-8 weeks and 1/2 slice of wheat bread or 1 wheat cracker for 12 weeks, otherwise you may end up with false negative results.

    For a celiac disease antibody test, a clinician collects a small amount of the patient's blood. The sample is then sent to a lab, where the blood cells are then removed, and the test is conducted.

    Celiac Disease Blood Tests

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    Note that the accuracy and specificity of each test can vary depending on the laboratory performing the test, the specific method used, and the population being tested. Sensitivity refers to the ability of a test to correctly identify individuals with the condition (true positive rate), while specificity refers to the ability of a test to correctly identify individuals without the condition (true negative rate).

    tTG-IgA (tissue transglutaminase IgA) Blood Test for Celiac Disease

    This test measures the levels of IgA antibodies to tissue transglutaminase, an enzyme that is involved in the immune response to gluten in those who have celiac disease.

    The test is estimated to have a sensitivity of approximately 90%, which means that it correctly identifies 90% of people with celiac disease. It also has a high specificity of around 95%, which means that it correctly identifies 95% of people who do not have celiac disease.

    Other Names for the tTG-IgA Test:

    • Tissue Transglutaminase IgA Test
    • Anti-Tissue Transglutaminase IgA Test
    • tTG-IgA Blood Test
    • tTG-IgA Serology Test
    • IgA-tTG Antibody Test
    • Tissue Transglutaminase Antibody IgA Assay

    tTG-IgG (tissue transglutaminase IgG) Blood Test for Celiac Disease

    This test measures the levels of antibodies to tissue transglutaminase, but it specifically measures IgG antibodies rather than IgA antibodies which are produced in people who eat gluten and have celiac disease. It is not as sensitive or specific as the tTG-IgA test, but it may be useful in cases where a person has an IgA deficiency, which can occur in approximately 2-3% of people with celiac disease. In these cases, the tTG-IgG test may be positive while the tTG-IgA test is negative. However, the tTG-IgG test is not recommended as a first-line screening test for celiac disease.

    The sensitivity of the tTG-IgG blood test is generally high, ranging from 85% to 98%. This means that the test can accurately detect celiac disease in a significant percentage of people who have the condition.

    The specificity of the tTG-IgG blood test is also high, typically around 90% to 98%. This indicates that the test can effectively rule out celiac disease in individuals who do not have the condition.

    Other Names for the tTG-IgG Test:

    • Tissue Transglutaminase IgG Test
    • Anti-Tissue Transglutaminase IgG Test
    • tTG-IgG Blood Test
    • tTG-IgG Serology Test
    • IgG-tTG Antibody Test
    • Tissue Transglutaminase Antibody IgG Assay

    EMA-IgA (endomysial antibodies IgA) Blood Test for Celiac Disease

    This is a highly accurate test for celiac disease, that requires specialized expertise to perform and interpret, and it is more expensive than other blood tests. It is generally used as a last test to confirm celiac disease after a positive tTG-IgA test.

    The sensitivity of a test refers to its ability to correctly identify individuals with the condition. For the EMA-IgA blood test, the sensitivity is generally very high, ranging from 90% to 98%. This means that the test can accurately detect celiac disease in a significant percentage of people who have the condition.

    The specificity of a test refers to its ability to correctly identify individuals without the condition. For the EMA-IgA blood test, the specificity is also high, typically around 95% to 100%. This indicates that the test can effectively rule out celiac disease in individuals who do not have the condition.

    Other Names for the EMA-IgA Test:

    • Endomysial Antibodies IgA Test
    • Anti-Endomysium Antibodies IgA Test
    • Endomysial Antibody IgA Assay
    • EMA IgA Blood Test
    • EMA-IgA Serology Test
    • Endomysium IgA Ab

    DGP-IgA and DGP-IgG (Deamidated Gliadin Peptide) Blood Tests for Celiac Disease

    These tests measure the levels of antibodies in the blood, but specifically targets deamidated gliadin peptides, which are a type of gluten protein that can trigger an immune response in people with celiac disease. The tests are not always included in adults, but should be in cases with IgA deficiency. The tests should always be included when screening children, especially if they are under 2 years old. The DGP tests were created to detect celiac disease in those with IgA deficiency, and there are here is more information about them:

    • DGP-IgA Test: This test measures the levels of IgA antibodies specific to deamidated gliadin peptide. IgA antibodies are produced by the immune system in response to gluten exposure. In individuals with celiac disease who produce normal levels of IgA, a positive DGP-IgA test result suggests the presence of ongoing immune response to gluten.
    • DGP-IgG Test: The DGP-IgG test measures IgG antibodies against deamidated gliadin peptide. IgG antibodies are another type of immune response and may be elevated in individuals with celiac disease who have IgA deficiency (a common occurrence in celiac disease).

    The DGP-IgA test is considered to have high sensitivity and specificity. In general, the DGP-IgA test has been reported to have a sensitivity ranging from 75% to 95% and a specificity ranging from 90% to 100%. Overall, the DGP tests, including DGP-IgA and DGP-IgG, exhibit a sensitivity of approximately 85-95% and a specificity of about 95-98%.

    Other Names for the DGP-IgA Test:

    • Gliadin Peptide Antibody IgG (Immunoglobulin A)
    • Anti-Gliadin Antibody IgA (AGA IgA)
    • Anti-Gliadin IgA Antibody (AGA IgA)
    • Anti-Gliadin IgA (AGA IgA)
    • Anti-Gliadin Immunoglobulin A Antibody (AGA IgA)
    • Anti-Deamidated Gliadin Peptide IgA (DGP IgA)
    • Anti-Deamidated Gliadin Antibody IgA (DGP IgA)

    The sensitivity of the DGP-IgG test is reported to range from 75% to 85%, which means it can correctly identify individuals with the condition in about 75% to 85% of cases. The specificity of the DGP-IgG test is reported to range from 75% to 95%, which means it can correctly identify individuals without the condition in about 75% to 95% of cases. Overall, the DGP tests, including DGP-IgA and DGP-IgG, exhibit a sensitivity of approximately 85-95% and a specificity of about 95-98%.

    Other Names for the DGP-IgG Test:

    • Gliadin Peptide Antibody IgG (Immunoglobulin G)
    • Anti-Gliadin Antibody IgG (AGA IgG)
    • Anti-Gliadin IgG Antibody (AGA IgG)
    • Anti-Gliadin IgG (AGA IgG)
    • Anti-Gliadin Immunoglobulin G Antibody (AGA IgG)
    • Anti-Deamidated Gliadin Peptide IgG (DGP IgG)
    • Anti-Deamidated Gliadin Antibody IgG (DGP IgG)

    IgA Levels/Deficiency Blood Test

    This should always be included in any blood panel for celiac disease, but it does not test directly for celiac disease, and is done to determine the accuracy of the other blood tests. People who are IgA deficient may score lower, of have no measurable levels on certain celiac disease blood tests. This test measures the levels of Immunoglobulin A (IgA) in the bloodstream. IgA is an important antibody that plays a significant role in the immune system, particularly in protecting the body's mucosal surfaces (e.g., respiratory and digestive tracts). Low IgA levels can indicate IgA deficiency, a condition where the body does not produce enough IgA, leading to an increased risk of infections and other health issues. The IgA Levels/Deficiency Test helps healthcare providers diagnose and monitor IgA-related conditions.

    Other Names for the IgA Levels/Deficiency Test:

    • Immunoglobulin A (IgA) Test
    • Total IgA Test
    • Serum IgA Test
    • IgA Serum Levels Test
    • IgA Blood Test
    • IgA Quantitative Test
    • IgA Antibody Test
    • IgA Immunodeficiency Test

    Celiac Disease Blood Antibody Screening is ~98% Accurate in Adults Using the Mayo Clinic Protocol 

    A celiac disease blood panel includes several tests to determine whether someone has celiac disease. These tests are very specific because certain antibodies only appear in those with gluten sensitivity, celiac disease and/or dermatitis herpetiformis. 

    Testing begins with a test called Immunoglobulin A (IgA). If the results are normal, then a Tissue transglutaminase, antibody, IgA test is given. A weak positive should lead to the following tests:

    1. Endomysial antibodies (IgA) and;
    2. Gliadin (deamidated) antibody, IgA.

    If the initial Immunoglobulin A (IgA) test is lower than normal, then these two tests should be done:

    1. Tissue transglutaminase antibodies, IgA and IgG profle.
    2. Gliadin (deamidated) antibodies evaluation, IgG and IgA.

    If the initial Immunoglobulin A (IgA) test is below the level of detection (<1.0 mg/dL), then these two tests should be done:

    1. Tissue transglutaminase (tTG) antibody, IgG.
    2. Gliadin (deamidated) antibody, IgG.

    It sounds complicated, but it's pretty standard procedure now, and when blood screening is done this way the results for celiac disease are ~98% accurate.

    Many People Can Be Diagnosed Using Only Blood Tests and No Biopsy

    According to the latest research, if the blood test results are at certain high levels that range between 5-10 times the reference range for a positive celiac disease diagnosis, it may not be necessary to confirm the results using an endoscopy/biopsy:

    Biopsy Still Standard in Adult Celiac Diagnosis

    After positive blood tests some doctors still require a biopsy to confirm the diagnosis. However, this is changing, as new techniques allow doctors to accurately detect celiac disease in adults without a biopsy.

    Remember, nearly all tests and screening for celiac disease require the patient to be eating a gluten-containing diet before testing, usually you should be eating at least 1/2 slice of wheat bread or 1 wheat cracker daily for at least 2 weeks before the endoscopy. Be sure to check with your doctor for the latest protocol.

    Blood Tests for Follow Up Care

    Blood tests may also be useful in follow up care in those with celiac disease to confirm that their diet is indeed free of gluten. Also, because of the lack of standardization, keep in mind that blood test results may not be directly comparable from one lab to the next.

    More Celiac Disease Testing Resources

    Blood Test Questions on the Celiac Disease and Gluten-Free Forum

     

    Read more at mayocliniclabs.com



    User Feedback

    Recommended Comments



    Guest Paula

    Posted

    This article was helpful - to a point. My 6 year old daughter has had tummy issues her whole life. To make a short story we had her blood tested & her antibody results were so high-off the chart- that her pediatrician said a biopsy wasn't necessary. She has celiac...period.

    My husband has had the same symptoms nearly his whole life (that's why we ignored our daughter's for so long). He got his blood tested. His antibodies were also off the charts - and again we were told by his doctor that a biopsy isn't necessary. "he has Celiac".

    We were told by 2 different doctors that a biopsy wasn't necessary. But all the research I've read said that the blood tests weren't 100% accurate.

     

    Both my husband & daughter have been gluten free for 2 months now. My husband's digestive issues have all but disappeared. My daughter however, still has very loose stools, but she's only going once a day instead of several times a day. I"m torn between giving her system a little more time, or requesting that biopsy after all.

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    Guest Rose

    Great website for someone new to celiac disease. I just got my blood test results and think it says I do not have celiac Even though I still think I do and will begin a gluten-free diet. Results were (ttg)ab,iga <3; iga,serum 141. The thing that is throwing me is the iga serum.

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    Guest Tim

    False negatives and false positives don't bode well for someone with tendencies toward hypochondria. When I do the gluten elimination diet strictly I feel better but it could be a placebo effect. That's why the blood tests are appealing to me; so I can take my double-guessing self out of the loop, but if they aren't accurate enough to provide greater certainty that the elimination diet then what's the point? Well, anyway this article answered several questions for me including the need to go back on gluten prior to the test and your insightful comments provided a ballpark figure for how long to go back on before testing.

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    Guest Tim

    Does anyone else get rhinitis (stuffy runny nose and sneezing) during their reactions or is it strictly gastro-intestinal for you?

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    Guest Ayrnn
    Does anyone else get rhinitis (stuffy runny nose and sneezing) during their reactions or is it strictly gastro-intestinal for you?

    I have been having terrible gastrointestinal problems. Had an ultrasound and blood work. Nothing turned up. Since, someone mention perhaps gluten is the problem. I cut it out for 3 days, and the tummy troubles are gone. I have had rhinitis all my life, post nasal drip all night long, been on allergy pills of every type. I am hoping with a little more time on the gluten free diet, this will be alleviated. Keep me posted on your end. PS - going today for the blood work for the antibody to gluten. I am hoping 3 days off of gluten will be ok for an accurate reading. Although, prior to my gluten free diet, I could barely eat anything...that lasted more than a month!

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    Guest Ashley P

    Posted

    This article helps a lot. I have gastrointestinal problems, dermatitis rashes that appear on my foot every 3-4 ish months, and geographic tongue. I'm more at risk for celiac b/c I also have Hashimoto's thyroiditis, but the one antibody test(IA-2) came back negative. I'm thinking my autoimmune disease might be affecting the test results, and am going gluten free to be sure.

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    Guest Tami
    This article helps a lot. I have gastrointestinal problems, dermatitis rashes that appear on my foot every 3-4 ish months, and geographic tongue. I'm more at risk for celiac b/c I also have Hashimoto's thyroiditis, but the one antibody test(IA-2) came back negative. I'm thinking my autoimmune disease might be affecting the test results, and am going gluten free to be sure.

    A biopsy of your rash may be all you need. They say it is 100% sure indicator for celiac. I'd ask your dermatologist about it.

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    Guest Dianna

    Posted

    This article was helpful - to a point. My 6 year old daughter has had tummy issues her whole life. To make a short story we had her blood tested & her antibody results were so high-off the chart- that her pediatrician said a biopsy wasn't necessary. She has celiac...period.

    My husband has had the same symptoms nearly his whole life (that's why we ignored our daughter's for so long). He got his blood tested. His antibodies were also off the charts - and again we were told by his doctor that a biopsy isn't necessary. "he has Celiac".

    We were told by 2 different doctors that a biopsy wasn't necessary. But all the research I've read said that the blood tests weren't 100% accurate.

     

    Both my husband & daughter have been gluten free for 2 months now. My husband's digestive issues have all but disappeared. My daughter however, still has very loose stools, but she's only going once a day instead of several times a day. I"m torn between giving her system a little more time, or requesting that biopsy after all.

    Paula - I found your comment to mean the most to our situation. My son was diagnosed with Celiac and also has "off the chart" blood tests for all 4 antibodies. The strange thing was that he is asymptomatic. I made the connection myself based on a tooth enamel defect that was found at the dentist office. We have all been tested (my husband, daughter and myself) and are awaiting the results. I am sure that I have it was well. Anyway, our doc was pushing the biopsy even though the blood tests were so compelling. We have chosen not to do that as my son just had his tonsils out and I do not want to put him through that right now. We have chosen to just eliminate the gluten altogether. I hope we have made the right choice. Did you ever have the biopsy done on your daughter?

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    Guest Marta
    This article was helpful - to a point. My 6 year old daughter has had tummy issues her whole life. To make a short story we had her blood tested & her antibody results were so high-off the chart- that her pediatrician said a biopsy wasn't necessary. She has celiac...period.

    My husband has had the same symptoms nearly his whole life (that's why we ignored our daughter's for so long). He got his blood tested. His antibodies were also off the charts - and again we were told by his doctor that a biopsy isn't necessary. "he has Celiac".

    We were told by 2 different doctors that a biopsy wasn't necessary. But all the research I've read said that the blood tests weren't 100% accurate.

     

    Both my husband & daughter have been gluten free for 2 months now. My husband's digestive issues have all but disappeared. My daughter however, still has very loose stools, but she's only going once a day instead of several times a day. I"m torn between giving her system a little more time, or requesting that biopsy after all.

    My GI doctor told me there is no way to diagnose just on the blood test. My doctor told me the same thing yours did. I was way off the chart as well...she told me I had celiac and to go on a gluten free diet. My GI doctor was very upset that she told me to go on the diet BEFORE I saw him. He said he HAS to do a biopsy to say I have celiacs.

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    Guest Jan
    Does anyone else get rhinitis (stuffy runny nose and sneezing) during their reactions or is it strictly gastro-intestinal for you?

    I get a runny nose as soon as I eat anything with gluten in it. I went on an elimination diet for 4 weeks because I was suffering from diarrhea, skin rashes, canker sores, gas, etc. The elimination diet cleared all of my symptoms. In trying things afterward, I got an immediate reaction to bread, so now I am off gluten completely.

     

    I don't think you need a doctor to tell you that you are gluten intolerant. They seem to have a protocol for "diagnosing" someone with celiac that includes the biopsy and tests, but the disease is on a continuum. Not everyone will test positive for every test, but if eliminating gluten helps, you should do it!

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    Guest Erika

    I am 19 and since I was little I have had stomach issues and chronic constipation. Now more recently I am having severe acne issues, and now am missing periods. I had a colonoscopy about a year ago and everything was fine. I went to a gynecologist and she tested my thyroid levels and my general physician said an antibody level was high but the thyroid function was okay. He sent me for blood work to test for celiac because I have a family history on my mom's side. He called with the results today and said "everything was normal". I am so frustrated because all he is doing is giving me medicine to help me go to the bathroom but they either make me sick or don't work at all, the only thing that works is Exlax. I want to push for an upper g.i. but I don't want to waste the time and money if i really don't have it. I don't know what else to do and it seems like since he can't figure out whats wrong he is just giving up. What do I do? Please help.

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    Guest Wanda
    Does anyone else get rhinitis (stuffy runny nose and sneezing) during their reactions or is it strictly gastro-intestinal for you?

    Tim,

    I get a runny nose immediately when eating something with gluten in it- I mean within 2-3 minutes! It is quite amazing and annoying at the same time!

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  • About Me

    Scott Adams

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


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