Selective immunoglobulin A deficiency and coeliac disease: Immune response dynamics

Abstract Objective To analyse the serological immune response in paediatric patients with selective immunoglobulin A deficiency (SIgAD) and coeliac disease (CeD), focusing on immunoglobulin G antibody dynamics after starting the gluten‐free diet (GFD). Methods Data from SIgAD patients with a CeD diagnosis, age less than 18 years, was retrospectively collected by the participating centres in this observational, multicentre, pan‐european registry, conducted by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Coeliac Disease Special Interest group. The analysis of the dynamics of normalisation of different IgG antibodies was conducted using non‐parametric Kaplan–Meier curves. Results At diagnosis, there is no correlation between mucosal damage and serological levels and a small bowel biopsy is mandatory to confirm CeD in children with SIgAD. After starting a GFD IgG antibody levels decrease slowly in SIgAD patients with CeD, with 50% still serology positive after 3 years. It takes significantly longer for normalisation in those with IgG class anti‐transglutaminase antibodies (IgG‐TGA) baseline levels >×10 upper limit of normal (ULN). Early quantitative change in antibody levels was not predictive of final serological normalisation. Conclusion Decision‐making on invasive tests based exclusively on the follow‐up antibody results should be avoided, given that IgG‐class antibodies resolve much more slowly after commencing a GFD, especially in those patients with high baseline IgG‐TGA levels.

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Publication Details

Journal
Journal of Pediatric Gastroenterology and Nutrition
Published
2026-09-22
DOI
https://doi.org/10.1002/jpn3.70589
Primary Topic
Celiac Disease Research and Management
Type
article
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Selective immunoglobulin A deficiency and coeliac disease: Immune response dynamics

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Journal of Pediatric Gastroenterology and Nutrition
Celiac Disease Research and Management
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Selective immunoglobulin A deficiency and coeliac disease: Immune response dynamics

Joanna B. Bierła, Gemma Castillejo, Renata Auricchio, María Roca, Margreet M. S. Wessels, Alice Monzani, Alina Popp, Josefa Barrio Torres, Ilma Rita Korponay-Szabo, Peter Michael Gillett, Zrinjka Mišak, Henedina Antunes, Marco Crocco, C. Meijer, Gieneke Gonera-de Jong, Ester Donat, Raquel Vecino, Victorien M. Wolters, ESPGHAN Celiac Disease Special Interest Group, Carmen Ribes‐Koninck
article en

Abstract

Abstract Objective To analyse the serological immune response in paediatric patients with selective immunoglobulin A deficiency (SIgAD) and coeliac disease (CeD), focusing on immunoglobulin G antibody dynamics after starting the gluten‐free diet (GFD). Methods Data from SIgAD patients with a CeD diagnosis, age less than 18 years, was retrospectively collected by the participating centres in this observational, multicentre, pan‐european registry, conducted by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Coeliac Disease Special Interest group. The analysis of the dynamics of normalisation of different IgG antibodies was conducted using non‐parametric Kaplan–Meier curves. Results At diagnosis, there is no correlation between mucosal damage and serological levels and a small bowel biopsy is mandatory to confirm CeD in children with SIgAD. After starting a GFD IgG antibody levels decrease slowly in SIgAD patients with CeD, with 50% still serology positive after 3 years. It takes significantly longer for normalisation in those with IgG class anti‐transglutaminase antibodies (IgG‐TGA) baseline levels >×10 upper limit of normal (ULN). Early quantitative change in antibody levels was not predictive of final serological normalisation. Conclusion Decision‐making on invasive tests based exclusively on the follow‐up antibody results should be avoided, given that IgG‐class antibodies resolve much more slowly after commencing a GFD, especially in those patients with high baseline IgG‐TGA levels.

Journal of Pediatric Gastroenterology and Nutrition
Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), University of Debrecen (HU), Carol Davila University of Medicine and Pharmacy (RO), Leiden University Medical Center (NL), Royal Hospital for Children (GB), Istituto Giannina Gaslini (IT), Hospital Clínico San Carlos (ES), University Medical Center Utrecht (NL), Hospital Universitari i Politècnic La Fe (ES), Children's Memorial Health Institute (PL), Willem-Alexander Kinderziekenhuis (NL), Children's Hospital Zagreb (HR), Hospital Braga (PT), Hospital Universitario de Fuenlabrada (ES), Hospital Universitari Sant Joan de Reus (ES), Rijnstate Hospital (NL), Clinical Academic Center of Braga (PT), Wilhelmina Children's Hospital (NL), Instituto de Investigación Sanitaria La Fe (ES), University of Naples Federico II (IT)
Openalex Percentile: Top 9%
Celiac Disease Research and Management
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