Allergy & Intolerance

Endomysial IgA: Normal Values and What a Positive Result Means

A normal endomysial IgA (EMA) result is negative. EMA is reported as negative or positive with a titre rather than as a number; a positive result is highly specific for celiac disease and is virtually always interpreted together with anti-tTG IgA.

Doctor's Assessment Included

Endomysium IgA: what this test measures

This test detects IgA antibodies directed against endomysial tissue. It is one of the most specific tests for coeliac disease, with a specificity approaching 100% in experienced laboratories. It is often used to confirm positive anti-TTG results.

Endomysium IgA: why this value matters

Due to its very high specificity, a positive endomysium IgA result strongly supports a diagnosis of coeliac disease. This helps healthcare providers decide on further management including potential biopsy and dietary intervention.

Endomysium IgA: how the blood test works

Referral: No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw: A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Which test: on its own €63,- Celiac Disease · €184,-
Where: 650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Endomysium IgA: how to prepare

Preferably keep eating gluten
Recommended

This test is only reliable if you ate gluten normally for the 6 weeks before.

Water is always fine. Drink as usual beforehand, it makes the draw easier.
Take your usual medication, unless your own doctor told you otherwise.

Endomysium IgA: when is testing worthwhile?

Endomysium IgA is typically ordered alongside or after anti-TTG testing to confirm coeliac disease. You must be consuming gluten regularly at the time of testing. Consult your healthcare provider for guidance on when this test is appropriate.

Endomysium IgA: symptoms of a high or low value

Low Levels

A negative endomysium IgA result is reassuring and suggests coeliac disease is unlikely, provided you were consuming gluten and do not have IgA deficiency. Some individuals with mild coeliac disease may still test negative.

High Levels

A positive endomysium IgA is strongly associated with coeliac disease. Common symptoms include chronic diarrhoea, bloating, fatigue, weight loss, anaemia, and in children, growth problems. Your healthcare provider will guide the next diagnostic steps.

Endomysium IgA: lifestyle and this value

If coeliac disease is confirmed, a strict gluten-free diet is essential. Gluten is found in wheat, barley, and rye. Reading food labels carefully and working with a dietitian ensures nutritional adequacy while avoiding gluten.

Endomysium IgA: frequently asked questions

How is the endomysium IgA test different from anti-TTG?

Both target related aspects of the coeliac immune response. Anti-TTG is more sensitive and used for initial screening, while endomysium IgA is more specific and often used for confirmation.

Can this test be falsely negative?

Yes — if you have IgA deficiency or are on a gluten-free diet, the test may produce a false-negative result.

Do I need a biopsy if endomysium IgA is positive?

In many adult cases, a biopsy is recommended to confirm the diagnosis. However, guidelines are evolving, and some cases with very high antibody titres may allow a no-biopsy diagnosis. Discuss this with your healthcare provider.