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Response to Letter: 'Serological exclusion of coeliac disease: an audit of anti-tissue transglutaminase and immunoglobulin A testing'.

We thank Shanahan et al. for their comments, regarding the importance of ruling out selective immunoglobulin A (IgA) deficiency in patients with negative anti-tissue transglutaminase (TTG). In our study [1], we have found that screening for coeliac disease with TTG antibodies is common in general population, with incidence varying by age and demographic characteristics. In our study, a large portion of subjects with positive coeliac disease serology did not proceed to confirmatory gastrointestinal endoscopies (44.1% of children and 47.1% of adults), further emphasizing the lack of adherence, in real life, to any guidelines for the diagnosis of coeliac disease. Our study did not include data regarding IgA deficiency. Thus, we fully agree with Shanahan et al., that testing for total IgA should be obligatory in the diagnostic workup for coeliac disease, in particular when IgA-dependent TTG are negative, in order to properly rule out coeliac disease. This is in line with European Society for Paediatric Gastroenterology, Hepatology and Nutrition recommendations [2], and further stresses the importance of following professional recommendation in real life.