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Point-of-care testing for coeliac disease antibodies — what is the evidence?

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To the Editor: The recent introduction of rapid point-of-care testing (PoCT) in Australian pharmacies to screen for coeliac disease has attracted controversy1 and provides an important opportunity to review the current literature.

PoCT provides a rapid (within 10 minutes) assessment of the presence or absence of coeliac disease-specific antibodies using a skin-prick blood sample. Based on lateral flow immunochromatography, circulating IgG and IgA antibodies to deamidated gliadin peptides, if present, bind to a membrane, which generates a coloured line of varying intensity.2 Total IgA antibodies are also assessed to detect the 3% of patients with coeliac disease who are IgA-deficient.

Coeliac Australia’s Medical Advisory Committee has developed a position statement, supported by the Royal College of Pathologists of Australasia, that reviews the evidence base for PoCT in coeliac disease and provides a detailed explanation of the technology used in currently available PoCT kits.3

The diagnostic accuracy of current assays to perform PoCT for coeliac antibodies is inferior to laboratory-based testing, particularly in the context of average-risk populations, where coeliac disease prevalence is relatively low.4,5