Referred Tests
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Test ID: EMA
Endomysial Antibodies, IgA, Serum
Useful For 
Suggests clinical disorders or settings where the test may be helpful
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 Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
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 in Special Instructions:
-Celiac Disease Comprehensive Cascade
-Celiac Disease Diagnostic Testing Algorithm
-Celiac Disease Gluten-Free Cascade
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
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.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Negative in normal individuals; also negative in dermatitis herpetiformis or celiac disease patients adhering to gluten-free diet.
Interpretation Provides information to assist in interpretation of the test results
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 Antibody, IgA, Serum and IGA / Immunoglobulin A (IgA), Serum levels are recommended.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
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 Recommendations for in-depth reading of a clinical nature
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 Nutr. 1984;6:529-534
4. Elwenspoek MMC, Jackson J, Dawson S, et al: Accuracy of potential diagnostic indicators for coeliac disease: a systematic review protocol. BMJ Open. 2020 Oct 5;10(10):e038994. doi: 10.1136/bmjopen-2020-038994