Antiendomysial
antibodies (EMA) are today considered the most sensitive and specific serological marker of
celiac disease (CD). The aim of the present study was to assess the occurrence of EMA of
IgG isotype in EMA
IgA negative children with clinical suspicion of malabsorption and their relationship with CD. Serum EMA
IgG1 determination was performed on 30 EMA
IgA negative children with clinical suspicion of CD. Total serum
IgA levels were further investigated. Sixty children with gastroenterological diseases other than CD were used as control disease patients and 63 healthy children were evaluated as the control group. Eighteen out of 30 children in the study showed EMA
IgG1 positivity in sera and a villous height/crypt depth ratio <3:1 as index of intestinal
atrophy. It is noticeable that a selective
IgA deficiency was present in only 9 of 18 EMA
IgG1 positive children. In addition, clinical symptoms, EMA
IgG1, and mucosal
atrophy disappeared after 8-10 mo on a
gluten-free diet. Neither EMA
IgA nor EMA
IgG1 were detected in the children in the control groups. The other 12 children in study group showed no histologic abnormalities and were EMA
IgG1 negative. In this study, we reveal a group of EMA
IgG1 CD children without
IgA deficiency. The diagnosis was based on the presence of
gluten-dependent typical serological and histologic features of CD. Our data suggest that EMA
IgG1 determination could be a new tool in the diagnostic workup of CD, useful in avoiding possible misdiagnosis.