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HelpTest Code EMA Endomysial Antibodies, IgA, Serum
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
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumOrdering 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 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 |
Special Instructions
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.
Cautions
A negative result (absence of circulating IgA-endomysial antibodies) does not exclude the diagnosis of dermatitis herpetiformis or celiac disease.
Patients with mild gluten-sensitive enteropathy may have a negative result.
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 daysSpecimen Retention Time
14 daysReject 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.