Celiac Disease Diagnostic Testing Algorithm

Testing for selective IgA deficiency

IGA / Immunoglobulin A (IgA), Serum

Normal or elevated IgA IgA <1 mg/dL

IgA ≥1 mg/dL and below age-matched

TTGA / Tissue Transglutaminase reference values Selective IgA deficiency*
(tTG) Antibody, IgA, Serum

■ TSTGP / Tissue Transglutaminase (tTG) ■ TTGG / Tissue Transglutaminase

<4.0 U/mL 4.0–10.0 U/mL >10.0 U/mL Antibodies, IgA and IgG Profile, Serum (tTG) Antibody, IgG, Serum
■ DGLDN / Gliadin (Deamidated) Antibodies ■ DGGL / Gliadin (Deamidated)
Evaluation, IgG and IgA, Serum Antibody, IgG, Serum
Celiac disease very unlikely. ■ DAGL / Gliadin (Deamidated)
Exception: Antibody, IgA, Serum
■ ~10% of patients with celiac ■ EMA / Endomysial Antibodies
Any result positive
disease are seronegative (IgA), Serum All results normal
or equivocal
If celiac disease is highly
suspected, consider CELI / Celiac Celiac disease very unlikely.
Associated HLA-DQ Alpha 1 and NEGATIVE POSITIVE Proceed to
(EMA negative and
Exception:
DQ Beta 1 DNA Typing, Blood (EMA positive and/or
biopsy ■ ~10% of patients with celiac
d-gliadin <20.0 Units) d-gliadin ≥20.0 Units)
disease are seronegative
If celiac disease is highly
suspected, consider CELI / Celiac
NEGATIVE POSITIVE
■ Possible false-positive tTG result Associated HLA-DQ Alpha 1 and
■ Celiac disease possible but unlikely DQ Beta 1 DNA Typing, Blood
If strong suspicion of celiac disease
Biopsy results inconsistent Celiac disease
remains, perform HLA typing.
with serology

CELI / Celiac Associated HLA-DQ Alpha 1

CELI / Celiac Associated HLA-DQ Alpha 1
and DQ Beta 1 DNA Typing, Blood
and DQ Beta 1 DNA Typing, Blood

POSITIVE NEGATIVE POSITIVE

NEGATIVE
for DQ2 or DQ8 for DQ2 or DQ8

Not celiac disease Possible celiac disease Not celiac disease Possible celiac disease

* For individuals with clinical symptoms suggestive of

Follow-up patient for future recurrent infections, suggest further evaluation for
development of celiac disease possible primary immunodeficiency:
IGGS / IgG Subclasses, Serum
IMMG / Immunoglobulins (IgG, IgA, and IgM), Serum

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