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Test Code 4232 Endomysial Antibodies (IgA), Serum

Performing Laboratory

Mayo Clinic 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) 46126-9

 

Result ID Test Result Name Result LOINC Value
9360 Endomysial Ab 46126-9

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

Method Name

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

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

Reflex Tests

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

Forms

If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-General Request (T239)

-Gastroenterology and Hepatology Client Test Request (T728)