Antibody Testing vs. Genetic Testing to Identify Celiac Disease Risk

Celiac disease is an autoimmune disease that occurs in genetically inclined individuals where the ingestion of gluten causes damage to the lining of the small intestine. There are over 300 signs and symptoms of celiac disease and the only current treatment is a 100% gluten-free diet. There are 3 factors that must be present to develop celiac disease: 1) Gluten – you must be ingesting gluten for the immune reaction to occur, 2) Genes – you must carry at least one of two genes (HLA alleles) associated with celiac disease and 3) Trigger – something must activate celiac disease such as environmental factors, stress or other underlying health issues. The number one question that we get is, what are the first steps I should take to see if I am at risk or have celiac disease? And should I do an antibody test or a genetic test for celiac disease?

Antibody Testing

Antibodies are produced by the immune system in response to substances that the body recognizes as harmful. The blood tests that most people are familiar with are antibody tests such as the tissue transglutaminase test (tTG) or the anti-endomysial (EMA) antibody test, which measures the autoimmune response triggered by gluten that occurs at a point in time. Antibody tests can suggest that a person is positive for celiac disease, but the test is not conclusive and an endoscopic biopsy will need to be performed to receive a proper diagnosis. In order to receive accurate results with antibody testing, gluten must have been consumed daily for several weeks prior to the time of testing. If one is not sure that they have celiac disease or may even just be at risk for the disease, antibody testing and biopsies can be costly, painful, and potentially unnecessary if DNA test results come back negative for celiac genetic risk.

Genetic Testing

Genetic testing for celiac risk involves collecting a DNA sample either through blood tests or a simple cheek swab like our at-home GlutenID^® test. When an individual is diagnosed with celiac disease, it is crucial to have the rest of the family tested, as they are now at risk for the autoimmune disease. First-degree relatives (parent, child, sibling) of someone that has been diagnosed with celiac disease have a 1 in 10 chance of developing the disease. Unlike antibody tests, gluten does not have to be consumed to perform a genetic test. This is helpful if an individual already knows that gluten causes a bad reaction in their body and are already on a gluten-free diet. It saves time, money and most importantly, it prevents illness and symptoms from returning. A simple genetic test can determine if further screening is needed or can completely rule out the possibility of developing celiac disease. If the genetic test is positive, then an antibody test is recommended for further screening and a conclusive diagnosis.

Non-Celiac Gluten Sensitivity

What if I’m not positive for celiac disease but still have a bad reaction to gluten?

If genetic test results are negative, but you still experience celiac-like symptoms when ingesting gluten, you may have non-celiac gluten sensitivity. There is currently no effective way to test for gluten sensitivity (also known as gluten intolerance) other than performing an elimination diet on your own. To do this, slowly start to eliminate gluten-containing foods and see if symptoms diminish and you start to feel better. Using a food journal may be helpful during this process to record symptoms and pinpoint exactly which foods are causing a negative reaction in your body.

Conclusion

We suggest taking a genetic test to rule out the possibility of developing celiac disease. An at-home genetic test like GlutenID^® is cost-effective, painless, and simple. If results are positive and celiac risk is elevated, we then advise to talk to your doctor about further screening such as antibody testing and if necessary, an endoscopic biopsy for a precise diagnosis.