Salivary and serum IgA antigliadin antibodies in dermatitis herpetiformis

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Abstract
Serum IgA class antigliadin antibodies (IgA‐AGA) are increased in untreated patients with coeliac disease and dermatitis herpetiformis (DH), and it has been suggested that salivary IgA‐AGA measurements could be used as a non‐invasive screening test for gluten‐sensitive enteropathy. In the present study salivary and serum IgA‐AGA were measured by an ELISA test in 10 untreated patients with DH. The results were compared to IgA‐AGA levels in nine patients with DH on a long‐term gluten‐free diet (GFD) and in 20 healthy control subjects on an ordinary diet. The mean serum but not salivary IgA‐AGA concentrations were significantly higher in the untreated than in the patients with DH on a long‐term GFD. When the 10 untreated patients with DH adhered to a GFD for 3 months, the rash disappeared and the mean serum IgA‐AGA decreased to normal levels, but no change was found in the mean salivary IgA‐AGA concentration. These results show that serum but not salivary IgA‐AGA measurements are suitable for monitoring GFD treatment in patients with DH. The discrepancy between the serum and salivary IgA‐AGA concentrations suggests that systemic and salivary IgA‐AGA responses are controlled separately.