Ten Times Normal Anti Tissue Transglutaminase Level Detected By Enzyme Linked Immunosorbent Assay (ELISA), But Normal Level by Chemiluminescent Assay (CLIA)

Fatemeh Elham Mahjoub^1, , Mehrnaz Farasat², Mehri Najafi Sani³, Azizollah Yousefi⁴, Pegah Pakzadian⁵, Fatemeh Farahmand⁶, Farzaneh Moatamed⁶, Pejman Rohani⁷, Shahindoqht Homayoun Valiane⁸, Alireza Nourbakhsh⁹ and Touran Akbari¹⁰

¹Tehran University of Medical Sciences, Tehran, Iran, Associate Professor in Pathology-Roshan Azma Pathobiology Laboratory, Tehran, Iran

²Tehran University of Medical Sciences, Tehran, Iran, Internist

³Tehran University of Medical Sciences, Tehran, Iran. Professor in Pediatric Gastro Enterology

⁴Iran University of Medical Sciences, Tehran, Iran, Associate Professor in Pediatric Gastro Enterology

⁵Roshan Azma Pathobiology Laboratory, Tehran, Iran, Bachelor of Laboratory Medical Sciences

⁶Tehran University of Medical Sciences, Tehran, Iran, Professor in Pediatric Gastro Enterology

⁷Tehran University of Medical Sciences, Tehran, Iran, Associate Professor in Pediatric Gastro Enterology

⁸Sophia Pathobiology Laboratory. Tehran, Iran

⁹Roshan Azma Pathobiology Laboratory, Tehran, Iran, Pathology Laboratory Technician

¹⁰0Roshan Azma Pathobiology Laboratory, Tehran, Iran, Master of Biochemistry

Cite this paper:
Fatemeh Elham Mahjoub, Mehrnaz Farasat, Mehri Najafi Sani, Azizollah Yousefi, Pegah Pakzadian, Fatemeh Farahmand, Farzaneh Moatamed, Pejman Rohani, Shahindoqht Homayoun Valiane, Alireza Nourbakhsh and Touran Akbari. Ten Times Normal Anti Tissue Transglutaminase Level Detected By Enzyme Linked Immunosorbent Assay (ELISA), But Normal Level by Chemiluminescent Assay (CLIA). International Journal of Celiac Disease. 2025; 13(1):1-3. doi: 10.12691/ijcd-13-1-1

Abstract

According to the new guidelines of the European Society for Pediatric Gastroenterology Hepatology and Nutrition [1], it is mandatory to test for anti tissue transglutaminase IgA (anti TTG IgA) and serum IgA in first step in the diagnosis of celiac disease. A diagnosis of celiac disease can be made when the anti-TTG IgA titer is ten times normal (with normal Ig A level) and anti-endomysial antibody (EMA) is positive in the second blood sample, without requiring biopsy. In this article, we present cases of anti TTG IgA levels more than ten times the upper limit of normal determined by ELISA (enzyme-linked immunosorbent assay). In some patients, EMA was checked and in all of these cases upper endoscopy and duodenal biopsy was performed for confirmation, Although biopsy was performed from the bulb and the second part of the duodenum, and the number of biopsies were adequate; no evidence of celiac disease was observed on histological examination. These patients were recruited, and another blood sample was taken and anti TTG IgA was checked by a chemiluminescence immunoassay (CLIA) and the levels were reported normal.

Keywords:
Celiac Disease Serology Anti Tissue Transglutaminase Enzyme Linked Immunosorbent Assay (ELISA) Chemiluminescent Immunoassay (CLIA)

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