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A 14-year-old girl with type 1 diabetes mellitus (T1DM) attends your clinic, following a negative TTG IgA at her 3-yearly coeliac disease (CD) screening. You reflect on the value of one-off HLA typing for CD in diabetic children, to avoid this 3 yearly test. You believe that the negative predictive value in those children without risk-HLA haplotypes associated with CD (HLA DQ2 or 8) is near to 100%, and therefore they would not need further TTG screening for CD. However, you wonder if there would be a significant number of patients with T1DM who are HLA DQ2 or DQ8 negative, which would make HLA typing unreliable as a screening test.
Structured clinical question
In a child with T1DM where CD screening is already in place (patient), would one-off HLA typing for CD (intervention) remove the need for 3 yearly TTG IgA/endomysial antibodies (EMA) blood testing? (outcome). …
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