About the Test
Purpose of the test
The purpose of celiac disease testing is to determine if a person has celiac disease and, if so, to evaluate their health and how the condition changes over time. This usually involves several types of tests and is overseen by a doctor or other health care provider.
Certain types of celiac disease tests are offered as at-home test kits for those individuals who are interested in celiac disease testing. However, some important celiac disease tests can only be performed in a medical setting. People concerned about celiac disease, including anyone with symptoms, should talk with a doctor about the most appropriate testing for them.
The following sections describe the different purposes of at-home and physician-ordered celiac disease testing.
Purpose of an at-home celiac disease test
There are no established guidelines for how at-home celiac disease tests should be used. In general, the purpose of an at-home celiac disease test is to obtain information about the possibility that a person has celiac disease. There are two types of at-home celiac disease tests: antibody tests and genetic tests.
Antibody tests: At-home tests can check a blood sample for the presence of antibodies that are associated with celiac disease. Antibodies are proteins produced by the immune system. Tests can look for specific antibodies that are usually only found at high levels in people who have celiac disease.
Genetic Tests: Another type of at-home test is a genetic test. It looks for particular genetic markers. People who do not have these markers are very unlikely to have celiac disease. However, many people who possess these genetic markers never develop celiac disease.
Purpose of a physician-ordered celiac disease test
Physician-ordered celiac disease testing always involves more than one test. Testing is used for diagnosis, screening, and monitoring of celiac disease.
Diagnosis involves testing to determine why a person is experiencing certain symptoms. Many conditions can cause similar symptoms as celiac disease, such as type 1 diabetes, autoimmune thyroid disease, and inflammatory bowel disease, so diagnostic testing is important to identify the cause. In celiac disease, a diagnosis is confirmed by tests that show both abnormal immune system activity and damage to the small intestine by performing a tissue biopsy.
Screening is testing to detect a health problem before it causes any symptoms. Some people without symptoms may have screening for celiac disease if they have a family history of the condition or other risk factors that make them more likely to have celiac disease.
Monitoring is testing that is done after a celiac disease diagnosis has been established to see how a patient’s condition has changed. Several kinds of tests can be used to assess a person’s health and how well they are responding to treatment with a gluten-free diet.
Additional information about physician-ordered testing can be found in our guide on Celiac Disease Testing.
What does the test measure?
Each type of at-home celiac disease test provides specific measurements. Two types of at-home tests are antibody tests and genetic tests.
Antibody tests
One type of at-home test measures antibodies in the blood that are associated with celiac disease. The immune system develops antibodies to help defend the body. Antibodies typically work by focusing on a specific foreign target, such as a virus or bacteria. However, in autoimmune disorders, antibodies target a person’s own healthy tissue. These are known as autoantibodies.
When people with celiac disease eat a gluten product, their body usually produces certain autoantibodies. At-home antibody tests can measure one or more of these autoantibodies that may be present when a person is consuming gluten.
Examples of these autoantibodies that may be detected in at-home testing include:
- Anti-tissue transglutaminase antibodies immunoglobulin A (tTG-IgA)
- Anti-tissue transglutaminase antibodies immunoglobulin G (tTG-IgG)
- Anti-endomysial antibody (EMA-IgA)
Tests can also look for antibodies that target a part of the gluten protein called gliadin. Examples of these antibodies include:
- Anti-deamidated gliadin peptide antibodies immunoglobulin A (DGP-IgA)
- Anti-deamidated gliadin peptide antibodies immunoglobulin G (DGP-IgG)
In general, testing for tTG-IgA is the preferred blood test for detecting celiac disease. The EMA-IgA antibody test is also considered to be a dependable way to check for celiac disease in most people. Tests for tTg-IgG and the DGP antibodies are not considered as reliable and are generally used in certain circumstances.
Genetic tests
Genetic tests are another option for at-home celiac disease testing. These tests look for specific variations in a person’s DNA that are associated with celiac disease.
These tests use a cheek swab to analyze a series of genes that regulate certain proteins that are on most cells in your body and are known as human leukocyte antigens (HLAs). HLA aids in regulating the immune system by differentiating your cells from those that are foreign. The main gene variations linked to celiac disease are called HLA-DQ2 and HLA-DQ8. An at-home test can detect whether a person has these gene variations. Some tests may also include other gene variants that are less frequently tied to celiac disease.
Having HLA-DQ2 or HLA-DQ8 does not mean a person has celiac disease, but people without these gene variations virtually never have the condition.
When should I get a celiac disease test?
No guidelines exist for when you should take an at-home celiac disease test.
You may consider an at-home celiac disease test if you want information about how likely it is that you have celiac disease. However, anyone considering at-home testing should be aware of its limitations, including that it cannot diagnose celiac disease.
At-home celiac disease tests should not be taken in lieu of seeing a doctor about this condition. Anyone with symptoms of celiac disease or risk factors for developing it should talk with their doctor about what kind of testing is most appropriate.
Benefits and Downsides of At-Home Celiac Disease Testing
If you’re thinking about at-home celiac disease testing, it may be helpful to consider the potential benefits and downsides of testing at home.
The main benefits of at-home celiac disease testing include:
- Convenience: At-home tests are non-invasive and can be conducted quickly in your own home. Taking the test does not require scheduling an appointment or traveling to a laboratory or medical office.
- Provides initial information: Although these tests cannot diagnose celiac disease, they can give you information to help initiate a conversation with your health care provider about your risk of celiac disease.
- Straightforward pricing: Most at-home tests have transparent pricing that includes the test kit with all required materials as well as shipping. Although the cost is not usually covered by health insurance, pricing is typically clear from the start.
Some of the potential downsides of at-home celiac disease testing include:
- Inability to diagnose celiac disease: Many people want a clear answer about their situation, but at-home tests cannot diagnose celiac disease. A series of laboratory tests need to be completed and, if positive, a biopsy is required to confirm a diagnosis of celiac disease. In addition, interpreting test results can be complex, and it may be difficult to understand the significance of at-home test results.
- Not covered by health insurance: Health insurance providers very rarely cover at-home testing, so you will likely need to pay out of pocket for at-home celiac disease tests.
Lack of medical consultation: At-home testing generally does not involve any detailed visit with a doctor or other health care provider about your current health or your personal and family health history. This type of medical consultation can be essential to proper diagnosis and treatment, especially if you have symptoms.
Types of At-Home Celiac Disease Tests
There are two main types of at-home celiac disease tests. Both are self-collection tests, which means that you collect a test sample at home, send it to a laboratory where it can be analyzed, and then receive results electronically.
One type of test requires a blood sample taken by pricking your fingertip. This kind of test checks the blood for antibodies that are linked to celiac disease. It is important to know that these tests may not be accurate if you already follow a gluten-free diet.
Another type of test analyzes your DNA to see if you have certain genes that are associated with celiac disease. This kind of test involves obtaining a sample by swabbing the inside of your cheek.
Below you can find information about top picks for each type of at-home celiac disease test.
Best Overall
imaware – Celiac Disease Screening Test
Price: $119
Type: Self-collection
Sample: Blood
Tests for: 4 antibodies (tTG-IgA, tTG-IgG, DGP-IgA, DGP-IgG)
Results timeline: Within 7 business days
The Celiac Disease Screening Test from imaware provides an analysis of four antibodies associated with celiac disease.
After the test kit arrives at your home, activate your test through the patient portal on the imaware website. To prepare your sample, prick your finger with a tiny needle provided in the kit and collect five drops of blood in a medical-grade tube and mail it to the CLIA-certified laboratory.
The test checks for both autoantibodies and antibodies to gliadin, a type of protein found in foods containing gluten. These antibodies include tTG-IgA, tTG-IgG, DGP-IgA, and DGP-IgG. Research suggests that including multiple antibodies in the test can help identify if you may have celiac disease. All results are reviewed internally by a health professional before they are posted in a secure online portal.
Once the lab receives your test kit, results are typically available within seven business days. The detailed test results are provided in an electronic report that shows the measurements of each antibody and indicates your likelihood of having celiac disease.
As with any celiac disease antibody test, you must be consuming gluten as part of your diet in order for the results to be accurate.
Best Genetic Test
Genovate – DNA Celiac Disease Test
Price: $249 + shipping
Type: Self-collection
Sample: Cheek swab
Tests for: HLA-DQA1*05, HLA-DQB1*02, HLA-DQB1*0302 alleles
Results timeline: Within a few business days
The Genovate DNA Celiac Disease Test is a noninvasive way to determine your susceptibility to celiac disease. The test analyzes a small section of your DNA, looking specifically at the HLA-DQA1*05, HLA-DQB1*02, and HLA-DQB1*0302 variations that have been connected with the disease.
The test kit is shipped directly to your home and contains detailed instructions. To obtain a sample, move the testing swab along the inside of your cheek for about 15 seconds. Then put the swab sample into the provided prepaid packaging, taking care in not letting the swab touch any other surface, and mail it back to the laboratory. Because this is a genetic test, no changes in diet are required before testing.
Once the test kit arrives at Genovate’s lab, the results of the DNA analysis are usually available within a few business days. You’ll receive a notification when the test results are ready to be viewed in the company’s online portal. All testing is done in a laboratory certified by the American Association of Blood Banks, College of American Pathologists (CAP), and the CLIA.
The test report shows if any genetic variants were found that can impact your risk for celiac disease. Almost all patients with celiac disease have these variants, however, not everyone who is positive for this test has celiac disease.
Most Affordable Genetic Test
Targeted Genomics – Gluten ID Test
Price: $195
Type: Self-collection
Sample: Cheek swab
Tests for: HLA-DQ2.2, HLA-DQ8, HLA-DQ2.5, HLA-DQ7 alleles
Results timeline: Within 14 business days
The Targeted Genomics Gluten ID Test is an affordable genetic testing kit that can help assess your susceptibility to celiac disease.
Once you receive the kit, register it on the Targeted Genomics website. Each test kit contains two swabs and specific instructions for obtaining the sample. The swabs are used to brush the inside of your cheek and are then placed in tubes for safe handling. The kit includes a prepaid mailer so that you can easily send the tubes to the CLIA-certified, CAP-accredited laboratory.
The sample is checked by the lab for genetic variations that are associated with celiac disease, including HLA-DQ2.2, HLA-DQ8, HLA-DQ2.5, and HLA-DQ7 alleles. You will be notified when results are available so that you can download a test report from the Targeted Genomics website. The report indicates if any genetic variants were found that could heighten your risk for celiac disease and can be shared with your health care practitioner to determine if follow-up testing is required.
Interpreting At-Home Celiac Disease Test Results
For at-home celiac disease tests, you will receive results through an online health portal or a smartphone app. The interpretation of the test report depends on which type of test that you took.
While the following sections provide an introduction to understanding the test report, you should always discuss your test results with a doctor. Your doctor can provide a detailed explanation of what the results may mean and address whether there is a need to repeat the test or order additional tests.
Interpreting at-home celiac disease antibody tests
At-home celiac disease blood tests measure the levels of one or more antibodies that are related to the condition. The test report will usually show the level of each antibody that was measured and may state whether that level is considered normal or abnormal.
Elevated antibody levels are common in people with celiac disease and rarely occur in people without celiac disease. High levels are an indication that you may have celiac disease, but blood tests alone cannot confirm a diagnosis.
Low antibody levels mean that the test did not find evidence of celiac disease. However, antibody levels are normally low in people who eat a gluten-free diet even if they have celiac disease. A negative result does not guarantee that you do not have celiac disease.
It is possible that your test shows that some antibody levels are elevated and others are normal. This may make it more challenging to understand the test result. Because interpreting antibody test results can be complex, it is essential to talk with a health care provider about the meaning of your at-home celiac disease blood test results.
Interpreting at-home celiac disease genetic tests
The results of an at-home genetic test will generally be reported as either positive or negative.
- A positive result means that your DNA includes the HLA-DQ2 or HLA-DQ8 gene variants. This does not mean you have celiac disease. About 30% of people have these genes, and only a small percentage of those develop celiac disease.
- A negative result indicates that your DNA does not have the genes associated with celiac disease. More than 99% of people with celiac disease have these gene variations, so a negative result means that it is very unlikely that you have the condition.
Genetic testing can help understand your risk for celiac disease, but it can’t determine for sure whether you have this condition. You should talk with a doctor or genetic counselor about genetic test results and their significance for your health.
Are test results accurate?
There is limited evidence about the accuracy of at-home celiac disease testing.
Some research has found that antibody tests using blood from a fingerstick are comparable in accuracy to tests that use blood drawn from a vein, but further studies are needed to confirm the accuracy of self-collected tests.
The reliability of test results from an at-home testing kit is dependent upon how closely you follow the kit’s instructions for collecting and shipping the sample. The results of antibody tests can also be affected by whether or not you are currently including gluten products in your diet. Although rare, it is also possible for the test to show no elevated antibodies in someone who has celiac disease, which is known as a false negative result.
For any specific at-home test brand, you can contact the testing company to ask about any research regarding the accuracy of their test methods. You can also talk with your health care provider about your test results and whether further confirmatory testing is needed.
Do I need follow-up tests?
It is common to need follow-up testing after taking an at-home celiac disease test. If the home test is positive, your health care provider will decide whether other laboratory tests need to be performed. A biopsy of the small intestine will be needed to definitively diagnose or rule out celiac disease.
Questions for your doctor after at-home celiac disease testing
You may learn more about your test results by preparing questions for your doctor. Examples of questions that may be helpful to ask include:
- What do my test results tell you about my risk for celiac disease?
- Are any tests needed to confirm my at-home test results?
- Do you recommend any follow-up tests?
- Do you suggest that I follow a gluten-free diet?
