Comparative study of direct and indirect immunofluorescence and of bullous pemphigoid 180 and 230 enzyme-linked immunosorbent assays for diagnosis of bullous pemphigoid

• Published in: Journal of the American Academy of Dermatology Vol. 69; no. 5; pp. 748 - 753
• Main Authors: Sárdy, Miklós, Kostaki, Dimitra, Varga, Rita, Peris, Ketty, Ruzicka, Thomas
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2013
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Autoantigens - analysis; bullous pemphigoid; bullous pemphigoid 180; bullous pemphigoid 230; Carrier Proteins - analysis; Child; Collagen Type XVII; collagen XVII; Cytoskeletal Proteins - analysis; Dermatology; diagnostics; Dystonin; Enzyme-Linked Immunosorbent Assay; esophagus; Female; Fluorescent Antibody Technique, Direct; Fluorescent Antibody Technique, Indirect; Humans; immunofluorescence; Male; Middle Aged; Nerve Tissue Proteins - analysis; Non-Fibrillar Collagens - analysis; Pemphigoid, Bullous - diagnosis; Retrospective Studies; sensitivity; Sensitivity and Specificity; specificity; Young Adult; DIF; bullous pemphigoid 230; collagen XVII; CI; IIF; BMZ; BP; bullous pemphigoid; diagnostics; specificity; sensitivity; esophagus; bullous pemphigoid 180; immunofluorescence; ELISA; indirect immunofluorescence; direct immunofluorescence; enzyme-linked immunosorbent assay; basement membrane zone; confidence interval
• ISSN: 0190-9622; 1097-6787; 1097-6787
• DOI: 10.1016/j.jaad.2013.07.009

Direct immunofluorescence (DIF), indirect immunofluorescence (IIF), and enzyme-linked immunosorbent assay (ELISA) are used for the laboratory diagnosis of bullous pemphigoid (BP). The diagnostic value of DIF and IIF on rabbit and monkey esophagus or human salt-split skin and commercial ELISAs was assessed. This was a single-center retrospective study where 313 patients with BP were compared with 488 control subjects. DIF was the most sensitive test (90.8%) whereas sensitivities for IIF on rabbit esophagus, IIF on monkey esophagus, IIF on salt-split skin, BP180 ELISA, and BP230 ELISA were 76.0%, 73.2%, 73.3%, 72.0%, and 59.0%, respectively. The sensitivity of the serologic tests was 88.8% altogether. The specificities for DIF, IIF on rabbit esophagus, IIF on monkey esophagus, IIF on salt-split skin, BP180 ELISA, and BP230 ELISA were 98%, 96.5%, 97.1%, 100%, 94.1%, and 99.2%, respectively. The retrospective nature of study was a limitation. Correlation of diagnostic data with clinical manifestations or disease course was not possible. In suspected BP, both serologic tests and DIF have to be performed because of a sensitivity issue. Although the ELISAs had a relatively low sensitivity, the serologic tests altogether almost reached the level of sensitivity of DIF. The specificities of all assays were excellent.