Diagnostic immunologique de la maladie cœliaque chez l’enfant. Mise au point

Summary Celiac disease is an autoimmune enteropathy induced by the gluten in genetically predisposed individuals. The production of the autoantibodies in the disease is a result of recognition by the immune system of tissue transglutaminase combined with the gliadin, inducing antibodies (ab) that are specific to celiac disease such as antigliadin (AGA), anti-endomysium (EMA) and antitissue transglutaminase (tTGA) antibodies. The children with CD may primarily show atypical or silent clinical forms with extradigestive symptoms, leading to delay of diagnosis and expose patients to serious complications. AGA, EMA and tTGA permit to identify patients for whom intestinal biopsy is recommended, to detect children running the risk of celiac disease and to assess the adherence to gluten free diet. Despite the need of an histological proof to confirm the disease, serologic tests have a great value in screening and diagnosing CD. To diagnose CD, it is recommended to initially seek for IgA tTGA isotypes, provided ruling out an IgA deficiency, mostly associated to CD. This first step should be followed by EMA test; which is a highly specific marker of the disease. The tTGA test for whom performances are relatively as good as those of EMA test is currently supplanting AGA test for the screening of the CD. It also represents an adequate tool for the follow-up of children under gluten free diet.