Is There a Role of Using a Rapid Finger Prick Antibody Test in Screening for Celiac Disease in Children?

Abstract

Introduction Celiac disease (CD) is an autoimmune disease triggered by gluten in genetically predisposed individuals. Despite the increasing prevalence of CD, many patients remain undiagnosed. Standard serology tests are expensive and invasive, so several point-of-care tests (POC) for CD have been developed. We aimed to determine the prevalence of CD in first-grade pupils in Primorje-Gorski Kotar County, Croatia, using a POC test. Methods A Biocard celiac test that detects IgA antibodies to tissue transglutaminase in whole blood was used to screen for celiac disease in healthy first-grade children born in 2011 and 2012 who consumed gluten without restrictions. Results 1478 children were tested, and none of them were tested positive with a rapid test. In 10 children (0,6%), IgA deficiency has been suspected; only 4 of them agreed to be tested further for total IgA, anti-tTG, and anti-DGP antibodies. IgA deficiency was confirmed in 3 patients, and in all 4 children, CD has been excluded. Conclusion Our results have not confirmed the usefulness of the POC test in screening the general population of first-grade schoolchildren. Further research is needed to establish the true epidemiology of CD in Primorje-Gorski Kotar County and to confirm the value of the rapid test in comparison with standard antibody CD testing.

Diagnostic accuracy of a novel point‐of‐care test for simultaneous detection of anti‐transglutaminase IgA and anti‐deamidated gliadin IgG antibodies

“…In our study, the fact that all study participants underwent a duodenal biopsy regardless of the tests allows us to rule out false‐negative cases of missed CD. The POCT for anti‐tTG IgA showed a very high sensitivity and specificity of 98.31% and 98.02% (with a PPV and NPV of 98.31% and 98.02%, respectively) and these results are better than those of other studies examining the same antibody class with lateral‐flow immunochromatographic technique 12,18 . Furthermore, a high diagnostic test accuracy of 98.17% with a perfect agreement (Cohen's kappa: 0.963) was shown compared with the reference standard methods.…”

“…This is one of the few POCT that uses this particular combination of celiac antibodies detection rather than the single detection of anti-tTG IgA/IgG or anti-DGP IgA/IgG, such as most POCTs devices present on the market. [12][13][14][15][16][17][18] In our study, the fact that all study participants underwent a duodenal biopsy regardless of the tests allows us to rule out false-negative cases of missed CD. The POCT for anti-tTG IgA showed a very high sensitivity and specificity of 98.31% and 98.02% (with a PPV and NPV of 98.31% and 98.02%, respectively) and these results are better than those of other studies examining the same antibody class with lateral-flow immunochromatographic technique.…”

“…In this study, the diagnostic accuracy of the simultaneous detection of anti‐tTG IgA and anti‐DGP IgG has been evaluated, and compared with the reference standard serological methods in patients with CD or suspected for CD. This is one of the few POCT that uses this particular combination of celiac antibodies detection rather than the single detection of anti‐tTG IgA/IgG or anti‐DGP IgA/IgG, such as most POCTs devices present on the market 12–18 . In our study, the fact that all study participants underwent a duodenal biopsy regardless of the tests allows us to rule out false‐negative cases of missed CD.…”

“…In the last decade, several POCTs detecting mostly anti-tTG IgA have been developed, but their role remains unclear in clinical practice either as a mass screening tool or, in a case-finding strategy, as a first-line instrument to be used in at-risk individuals before the use of conventional serology. [12][13][14][15][16][17] Previous studies have shown variable sensitivity or specificity of these tests compared with the conventional serology, even if a recent systematic review and meta-analysis reported a high pooled sensitivity and specificity of POCTs in diagnosing CD (94% and 94.4%, respectively). 18 The primary aim of this study was to assess the diagnostic accuracy of a novel anti-tTG IgA/anti-DGP IgG-based POCT, compared with conventional serology (reference) methods in people with CD or suspected for CD.…”

Modern Aspects of Celiac Disease Diagnosis in Children

“…Однако на данный момент POCT не должны заменять лабораторное тестирование или служить основанием для постановки окончательного диагноза, так как диагностическая ценность POCT зависит от интерпретации результатов подготовленным персоналом, проводящим тест [21]. Использование POCT для массового скрининга нецелесообразно [22].…”