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Test Code EMA Endomysial Antibodies (IgA), Serum

Reporting Name

Endomysial Abs, S (IgA)

Useful For

Diagnosis of dermatitis herpetiformis and celiac disease

 

Monitoring adherence to gluten-free diet in patients with dermatitis herpetiformis and celiac disease

 

Because of the high specificity of endomysial antibodies for celiac disease, the test may obviate the need for multiple small bowel biopsies to verify the diagnosis. This may be particularly advantageous in the pediatric population, including the evaluation of children with failure to thrive.

Testing Algorithm

If EMA / Endomysial Antibodies (IgA), Serum is positive or indeterminate, EMAT / Endomysial (IgA), Titer, Serum will be performed at an additional charge.

 

The following algorithms are available in Special Instructions:

-Celiac Disease Comprehensive Cascade

-Celiac Disease Diagnostic Testing Algorithm

-Celiac Disease Gluten-Free Cascade

-Celiac Disease Routine Treatment Monitoring Algorithm

-Celiac Disease Serology Cascade

Performing Laboratory

Mayo Medical Laboratories in Rochester

Specimen Type

Serum


Specimen Required


Container/Tube: 

Preferred: Serum gel

Acceptable: Red Top

Specimen Volume: 2 mL


Specimen Minimum Volume

Adults: 1 mL/Pediatric: 0.5 mL

Specimen Stability Information

Specimen Type Temperature Time
Serum Refrigerated (preferred) 14 days
  Frozen  30 days
  Ambient  14 days

Reference Values

Negative in normal individuals; also negative in dermatitis herpetiformis or celiac disease patients adhering to gluten-free diet.

Day(s) and Time(s) Performed

Monday through Friday; 7 a.m.-5 p.m.

Test Classification

This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

86255-screen

86256-titer (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
EMA Endomysial Abs, S (IgA) 27038-9

 

Result ID Test Result Name Result LOINC Value
9360 Endomysial Ab 27038-9

Clinical Information

Circulating IgA endomysial antibodies are present in 70% to 80% of patients with dermatitis herpetiformis or celiac disease, and in nearly all such patients who have high grade gluten-sensitive enteropathy and are not adhering to a gluten-free diet.

 

For your convenience, we recommend utilizing cascade testing for celiac disease. Cascade testing ensures that testing proceeds in an algorithmic fashion. The following cascades are available; select the appropriate one for your specific patient situation. Algorithms for the cascade tests are available in Special Instructions.

-CDCOM / Celiac Disease Comprehensive Cascade: complete testing including HLA DQ

-CDSP / Celiac Disease Serology Cascade: complete testing excluding HLA DQ

-CDGF / Celiac Disease Gluten-Free Cascade: for patients already adhering to a gluten-free diet

 

To order individual tests, see Celiac Disease Diagnostic Testing Algorithm in Special Instructions.

Interpretation

The finding of IgA-endomysial antibodies (EMA) is highly specific for dermatitis herpetiformis or celiac disease.

 

The titer of IgA-EMA generally correlates with the severity of gluten-sensitive enteropathy.

 

If patients strictly adhere to a gluten-free diet, the titer of IgA-EMA should begin to decrease within 6 to 12 months of onset of dietary therapy.

 

Occasionally, the staining results cannot be reliably interpreted as positive or negative because of strong smooth muscle staining, weak EMA staining or other factors; in this case, the results will be recorded as "indeterminate." In this setting, further testing with measurement of TTGA / Tissue Transglutaminase (tTG) Antibody, IgA, Serum and IGA / Immunoglobulin A (IgA), Serum levels are recommended.

Clinical Reference

1. Peters MS, McEvoy MT: IgA antiendomysial antibodies in dermatitis herpetiformis. J Am Acad Dermatol 1989;21:1225-1231

2. Chorzelski TP, Buetner EH, Sulej J, et al: IgA anti-endomysium antibody: a new immunological marker of dermatitis herpetiformis and coeliac disease. Br J Dermatol 1984;111:395-402

3. Kapuscinska A, Zalewski T, Chorzelski TP, et al: Disease specificity and dynamics of changes in IgA class anti-endomysial antibodies in celiac disease. J Pediatr Gastroenterol Nutr1984;6:529-534

Analytic Time

2 days

Reject Due To

Hemolysis

Mild OK; Gross reject

Lipemia

Mild reject; Gross reject

Icterus

Mild OK; Gross reject

Other

NA

Method Name

Staining of Rhesus Monkey Esophagus Substrate by Indirect Immunofluorescence Assay (IFA) for IgA Endomysial Antibodies (EMA)

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
EMAT EMA Titer, S (IgA) No No