IgA immune response patterns to gliadin in serum.

The incidence, titer and molecular size of anti-gliadin (GL) IgA were analyzed in sera from children with celiac disease (CD, n = 66), hospitalized control children (n = 64) and children with other malabsorption disorders (n = 103). Anti-GL IgA was assessed by solid-phase radioimmunoassay, and its molecular size was analyzed by sucrose density gradient ultracentrifugation. The median anti-GL IgA titer was significantly higher in untreated CD than in the other groups, with some overlap. Whereas 57% of anti-GL IgA were polymeric IgA (pIgA) in acute CD, only 17% were pIgA in children with other malabsorption disorders. These anti-GL pIgA consisted mainly of dimers with in some children, a low proportion of anti-GL secretory IgA (SIgA). A large proportion of anti-GL pIgA was associated with high total serum IgA. After the onset of a gluten-free diet (GFD), anti-GL pIgA disappeared more quickly from serum than mIgA. During the gluten challenge test, anti-GL IgA comprised 20% pIgA when they reappeared in serum, but 59% pIgA at the end of the test. The presence of anti-GL pIgA in serum seems related to chronic exposure to gluten of CD patients with a flat intestinal mucosa. These serum pIgA antibodies could result from a spillover from the intestinal mucosal synthesis into the circulation.