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Endomysial Antibodies (IgA), Serum

Important Note

This test is no longer offered by Seattle Children's hospital. Note to Seattle Children's staff: inform ordering provider that testing will not be performed.  We offer a recommended test (below) that they can choose to add-on.


The recommended replacement is Deamidated gliadin peptide (IgA, IgG).  It measures the IgA and IgG isotypes of the gliadin protein after it has been selectively deamidated by tissue transglutaminase.  Studies have shown that the sensitivity and specificity of DGP, IgA and IgG for celiac disease are comparable to tissue transglutaminase, and higher than that of endomysial antibodies (EMA). In addition to tTG-IgA, DGP is recommended in place of EMA for IgA deficient patients (2% of our population), for patients in whom a second test is desired based on clinical history, and in patients less than two years of age.

Reporting Name

Endomysial Abs, S (IgA)

Useful For

Diagnosis of dermatitis herpetiformis and celiac disease


Monitoring adherence to gluten-free diet in patients with dermatitis herpetiformis and celiac disease


Because of the high specificity of endomysial antibodies for celiac disease, the 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.

Specimen Required


Preferred: Serum gel

Acceptable: Red Top

Specimen Volume: 2 mL

Seattle Children's Hospital Note:

Collect 4 mL whole blood in Red Top.

Specimen Type


Specimen Minimum Volume

Adults: 1 mL/Pediatric: 0.5 mL

Specimen Stability Information

Specimen Type Temperature Time
Serum Refrigerated (preferred) 14 days
  Frozen  30 days
  Ambient  14 days
Seattle Children's Hospital Note:

Ambient: 7d

Refrigerated: 14 d

Frozen: Unlimited

Day(s) and Time(s) Performed

Monday through Friday; 7 a.m.-5 p.m.

Seattle Children's Hospital Note:

TAT: 4 - 9 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Method Name

Staining of Rhesus Monkey Esophagus Substrate by Indirect Immunofluorescence Assay (IFA) for IgA Endomysial Antibodies (EMA)

Method Description

Frozen sections of rhesus monkey esophagus substrate are overlaid with dilutions of patient's serum, incubated, covered with fluorescein-conjugated IgA antiserum, and interpreted with a fluorescence microscope.(Chorzelski TP, Beutner 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; Kupascinska 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 1987;6:529-534)

Reference Values

Negative in normal individuals; also negative in dermatitis herpetiformis or celiac disease patients adhering to gluten-free diet.

Test Classification

This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information


86256-titer (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
EMA Endomysial Abs, S (IgA) 46126-9


Result ID Test Result Name Result LOINC Value
9360 Endomysial Ab 46126-9

Reject Due To


Mild OK; Gross reject


Mild reject; Gross reject


Mild OK; Gross reject



Testing Algorithm

If EMA / Endomysial Antibodies (IgA), Serum is positive or indeterminate, EMAT / Endomysial (IgA), Titer, Serum 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

-Celiac Disease Routine Treatment Monitoring Algorithm

-Celiac Disease Serology Cascade

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
EMAT EMA Titer, S (IgA) No No