Immunoglobulin A deficiency on serological coeliac screening: an opportunity for early diagnosis of hypogammaglobulinaemia.

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We present a serendipitous case of clinically significant pan-hypogammaglobulinaemia , diagnosed after routine serological testing for possible coeliac disease led first to identification of IgA deficiency (discovered as a low background in IgA-based routine serological screening ), and subsequently to confirmed pan-hypogammaglobulinaemia (antibody immunodeficiency ). Hypogammaglobulinaemia is a relatively rare diagnosis (estimated at 1 in 36 ,000 ), in which delayed diagnosis and treatment are associated with chronic organ damage including bronchiectasis . Routine serological testing for coeliac disease using the IgA anti-tissue transglutaminase (IgA TTG ) test is in widespread use and provides an opportunity for early diagnosis of hypogammaglobulinaemia . Routine serological screening for coeliac disease may uncover IgA deficiency , and we suggest that all IgA-deficient cases identified should also be checked for antibody deficiency by quantifying the other immunoglobulins (IgG , IgM ).