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EPIC ORDER CODE LAB4646 Endomysial Antibodies, IgA, Serum

Additional Codes

SQ: ENDABM

Reporting Name

Endomysial Abs, S (IgA)

Useful For

Analysis of IgA-endomysial antibodies for the diagnosis of dermatitis herpetiformis and celiac disease

 

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

Testing Algorithm

If the IgA-endomysial antibodies result is positive or indeterminate, then the antibody titer will be performed at an additional charge.

 

The following algorithms are available:

-Celiac Disease Comprehensive Cascade Test Algorithm

-Celiac Disease Diagnostic Testing Algorithm

-Celiac Disease Gluten-Free Cascade Test Algorithm

-Celiac Disease Routine Treatment Monitoring Algorithm

-Celiac Disease Serology Cascade Test Algorithm

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Serum


Ordering Guidance


Cascade testing is recommended 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.

-For complete testing including human leukocyte antigen (HLA) DQ, order CDCOM / Celiac Disease Comprehensive Cascade, Serum and Whole Blood

-For complete testing excluding HLA DQ, order CDSP / Celiac Disease Serology Cascade, Serum

-For patients already adhering to a gluten-free diet, order CDGF / Celiac Disease Gluten-Free Cascade, Serum and Whole Blood

 

To order individual tests, see Celiac Disease Diagnostic Testing Algorithm



Specimen Required


Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 2 mL

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
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) Performed

Monday through Friday

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 US Food and Drug Administration.

CPT Code Information

86231

86231-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.

 

Because of the high specificity of endomysial antibodies for celiac disease, this 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.

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 these cases, the results will be reported as "indeterminate" and additional testing is recommended. For more information  see TTGA / Tissue Transglutaminase Antibody, IgA, Serum and IGA / Immunoglobulin A (IgA), Serum.

Clinical Reference

1. Peters MS, McEvoy MT. IgA antiendomysial antibodies in dermatitis herpetiformis. J Am Acad Dermatol. 1989;21(6):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(4):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 Nutr. 1987;6(4):529-534. doi:10.1097/00005176-198707000-00006

4. Elwenspoek MMC, Jackson J, Dawson S, et al. Accuracy of potential diagnostic indicators for coeliac disease: a systematic review protocol. BMJ Open. 2020;10(10):e038994. doi:10.1136/bmjopen-2020-038994

Method Description

Frozen sections of primate esophagus substrate are overlaid with dilutions of patient's serum, incubated, covered with fluorescein-conjugated IgA antiserum, and interpreted with a fluorescence microscope.(Package insert: NOVA Lite Monkey Oesophagus IFA Kit/Slides. Inova Diagnostics; 05/2018)

Report Available

2 to 7 days

Specimen Retention Time

14 days

Reject Due To

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus Reject

Method Name

Indirect Immunofluorescence Assay (IFA)

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 a Gastroenterology and Hepatology Test Request (T728) with the specimen.