Diagnosis
Anti-TTG IgA (i.e. Anti-Tissue Transglutaminase IgA) is the first test you do. It is 1st-line. It has a sensitivity of 95% and specificity of 95%. You may add a total IgA because patients with IgA deficiency are at risk of a false negative. In IgA deficient patients, do an IgG-based DGP (anti-deamidated gliadin peptide antibody) or TTG test.
Confirming diagnosis: Biopsy of small intestines (shows villous atrophy, increased intraepithelial lymphocytes, crypt hyperplasia) and resolution of symptoms on a gluten-free diet
Dermatitis herpetiformis is a hallmark of the Celiac disease. It is a pruritic papular rash on extensor surfaces on the elbows, buttocks, and knees.
Patients should avoid gluten-containing grains like barley, wheat, barley, matzo flour, bran, and rye.
Patients who are diagnosed with celiac disease are at increased risk of osteoporosis due to bone loss from decreased calcium and vitamin D absorption. These patients are at higher risk for fractures.
References
JAMA 2011;306(14):1582-1592.
Am Fam Physician 2014;89(2):99-105.