Ordering Recommendation

Acceptable reflex test to evaluate for suspected celiac disease (CD) in IgA-competent individuals. 

The preferred reflex test to screen for CD is Celiac Disease Reflexive Cascade, Serum (3016817).

New York DOH Approval Status

This test is New York state approved.

Specimen Required

Patient Preparation

Serum separator tube (SST).

Specimen Preparation

Separate serum from cells ASAP or within 2 hours of collection. Transfer 1 mL serum to an ARUP standard transport tube. (Min: 0.5 mL)

Storage/Transport Temperature


Unacceptable Conditions

Contaminated, grossly hemolyzed, grossly icteric, or grossly lipemic.


After separation from cells: Ambient: 48 hours; Refrigerated: 1 week; Frozen: 30 days (avoid freeze/thaw cycles)


Semi-Quantitative Particle-Based Multianalyte Technology (PMAT)/Semi-Quantitative Indirect Fluorescent Antibody (IFA)




1-4 days

Reference Interval

Test Number
Reference Interval
  Tissue Transglutaminase (tTG) Ab, IgA 0.00 - 4.99 FLU

Interpretive Data

Tissue Transglutaminase Antibody, IgA: Presence of the tissue transglutaminase (tTG) IgA antibody is associated with gluten-sensitive enteropathies such as celiac disease and dermatitis herpetiformis. Individuals with positive results should be confirmed with small intestinal biopsy to establish celiac disease diagnosis. tTG IgA antibody concentrations greater than 50 FLU exhibits higher correlation with results of duodenal biopsies consistent with celiac disease. For antibody concentrations greater than or equal to 5 FLU but less than 10 FLU, additional testing for endomysial (EMA) IgA concentrations may improve the positive predictive value for disease. A decrease in tTG IgA antibody concentration after initiation of a gluten-free diet may indicate a response to therapy.

Compliance Category



In individuals who produce sufficient total IgA, the most sensitive and specific serologic test for celiac disease (CD) diagnosis is tissue transglutaminase (tTG) IgA. In individuals who are IgA deficient, tTG IgG and deamidated gliadin peptide (DGP) IgG antibody testing is recommended.

Reflexive panel testing is preferred to screen for CD.

Some patients may have positive tTG IgA results but negative endomysial antibody (EMA) IgA and/or DGP IgA results, which may indicate early disease or be associated with false positivity. Close clinical correlation with continued testing may be indicated in patients who have a family history or increased risk for CD. If serology is negative and suspicion for CD remains strong, intestinal biopsy may still be warranted to establish a diagnosis.

All serologic tests used to diagnose CD should be performed while the patient is on a gluten-containing diet. Upon initiation of a gluten-free diet, antibody titers decline in treatment-responsive patients, and the time frame to normalize titers varies by case.

Specimens are screened using tTG IgA by PMAT. If tTG IgA is 5.00 FLU or greater, then EMA IgA by IFA testing will be added. Additional charges apply. All EMA IgA by IFA testing is titered to endpoint.

Hotline History


CPT Codes

86364; if reflexed, add 86231


Component Test Code* Component Chart Name LOINC
0097709 Tissue Transglutaminase (tTG) Ab, IgA 46128-5
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.


  • Anti-EMA
  • Anti-Endomysial
  • Anti-Endomysial Antibody
  • Anti-tissue Transglutaminase Antibody
  • Antiendomysial
  • Antiendomysial Antibody
  • Celiac Disease
  • EMA
  • Gluten Sensitivity
  • Gluten-Sensitive Enteropathy Tests
  • Tissue Transglutaminase Ab IgA
  • tTG IgA
Tissue Transglutaminase Antibody, IgA With Reflex to Endomysial Antibody, IgA by IFA