EMA IgA optimal range and reference range
Compiled by Alina Radu, founder of Sera, from the published sources below · Last reviewed November 9, 2026
Sera's bands for EMA IgA:
- Optimal 0 – 1:5 titer; out of range below 0 or above 1:5 titer.
Evidence grade: Published reference interval. A band that primarily reflects a published adult laboratory or population reference interval. It is not necessarily applicable to every assay or laboratory.
All units
| Unit | Optimal | Sufficient | Out of range |
|---|---|---|---|
| titer | 0 – 1:5 | — | below 0 or above 1:5 |
No separate Sufficient band is currently defined for this marker.
What the evidence says
Endomysial antibody IgA is read by immunofluorescence and reported as negative or as a titre. The negative cut-off is set by each laboratory: some report negative below 1:5, others below 1:10 (ARUP), and some print only 'Negative'. Sera flags any titre from 1:5 upward; read the result against the cut-off printed on the report. Guidelines use EMA IgA as the second test, to confirm a positive or weakly positive tTG IgA, not as a stand-alone screen. The result is not valid in IgA deficiency, where an IgG-based test is used instead, and a negative result does not exclude coeliac disease, including in someone already on a gluten-free diet. No guideline sets a titre threshold, and the height of the titre has no agreed meaning.
Assay: Results differ meaningfully between platforms and methods. Compare against the interval printed by the issuing laboratory before acting on a borderline value.
Sources
- Endomysial Antibody, IgA by IFA — ARUP Laboratories, 2026 · Laboratory / reference-interval sourceSemi-quantitative indirect fluorescent antibody test with a reference interval of less than 1:10. This is one dilution step higher than Sera's proposed cut-off of 1:5; a laboratory using this interval does not report a titre of 1:5.
- EMAT - Overview: Endomysial Antibodies, IgA, Titer, Serum — Mayo Clinic Laboratories, 2026 · Laboratory / reference-interval sourceReference value is 'Negative' with no numeric titre; the titre is run only when the screen is positive or indeterminate. A negative result does not exclude coeliac disease or dermatitis herpetiformis.
- Anti Endomysial, IgA (by IFA) — University of Washington Department of Laboratory Medicine and Pathology, 2026 · Laboratory / reference-interval sourceReference range is 'Negative', by indirect immunofluorescence on monkey oesophagus. The laboratory states the test cannot be used in IgA deficiency.
- Coeliac disease: recognition, assessment and management (NG20), Recommendations — National Institute for Health and Care Excellence (NICE), 2015 · Clinical guidelinePublished 2 September 2015 and still the NICE guideline in force. Total IgA and IgA tTG are the first-choice tests; IgA EMA is used when IgA tTG is weakly positive; IgG EMA, IgG DGP or IgG tTG are considered if IgA is deficient. No titre cut-off is given.
- European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020 — Husby S, Koletzko S, Korponay-Szabó I, et al. — Journal of Pediatric Gastroenterology and Nutrition, 2020 · Clinical guidelinePaediatric guideline: initial testing is total IgA plus tTG IgA; an IgG-based test only if total IgA is low or undetectable. A no-biopsy diagnosis needs tTG IgA at 10 times the upper limit or more and a positive EMA IgA in a second blood sample. No EMA titre cut-off is given.
What EMA IgA (Endomysial Antibody IgA) measures
An IgA antibody against the endomysium, the connective tissue around muscle fibres, read by immunofluorescence. It detects the same target as tTG IgA by a different and more specific method.
The confirming test for coeliac disease: tTG IgA is the screen, and a positive endomysial antibody on a separate sample is what makes the result hard to explain any other way. Like tTG IgA it is falsely negative when total IgA is low, and it fades on a gluten-free diet. It is read by eye, so laboratories differ by a dilution. Sera stores the dilution denominator, so a report reading 1:20 is entered as 20, and a negative result reported as below the lowest dilution is entered as 0.