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Use of HLA Typing in Diagnosing Celiac Disease in Patients With Type 1 Diabetes

¹ Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, Australia
² Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia
³ Department of Medicine, University of Sydney, Sydney, Australia
⁴ Department of Endocrinology, Royal Alexandra Hospital for Children, Westmead, Australia
⁵ Department of Endocrinology, Women and Children’s Hospital, Adelaide, Australia
⁶ Department of Immunology, Royal Alexandra Hospital for Children, Westmead, Australia

Address correspondence and reprint requests to Andrew J. Williams, Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia. E-mail: andrew.williams{at}email.cs.nsw.gov.au

OBJECTIVE—This study examines the use of HLA typing for the diagnosis of celiac disease in a group of Australians with type 1 diabetes.

RESEARCH DESIGN AND METHODS—Subjects included 131 sequential patients with type 1 diabetes (mean age 17 years [range 10–37]), 77 patients with biopsy-proven celiac disease (mean age 52 years [range 12–84]), and 162 healthy control subjects (mean age 17 years [range 2 months to 56 years]). Subjects were prospectively screened for celiac disease using endomysial antibodies (EMAs), tissue transglutaminase antibodies (TTGAs), and celiac disease–specific HLA typing.

RESULTS—Celiac disease was diagnosed in 11 subjects after an intestinal biopsy (prevalence 8.4%). There was 95% agreement between TTGA and EMA for positive results and 100% for negative results. There was no significant difference for HLA DQ2 and DR4 among patients with type 1 diabetes with or without celiac disease.

CONCLUSIONS—The prevalence of celiac disease among patients with type 1 diabetes is higher than previously estimated in Australia. TTGA is a valuable diagnostic tool that can be used for screening celiac disease in patients with type 1 diabetes. HLA typing should not be used in the diagnosis of celiac disease in patients with type 1 diabetes because of the similarities of HLA types between patients with type 1 diabetes and those with celiac disease.

Abbreviations: EMA, endomysial antibody • HSAP, human signaling lymphocyte activation molecule–associated protein • TTGA, tissue transglutaminase antibody

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