title: Autoantibody detection in bullous pemphigoid: clinical evaluation of the EUROPLUS™ Dermatology Mosaic.
abstract: Bullous pemphigoid (BP) is an autoimmune blistering skin disease. Autoantibodies to BP180 and BP230 can be detected by indirect immunofluorescence (IIF) on different substrates (oesophagus, salt-split-skin, BP180-antigen dots, BP230-transfected cells) and ELISA. Here, we compared test characteristics of these test systems. We analysed sera from BP patients (n=60) in whom the clinical diagnosis had been confirmed histopathologically. The control cohort comprised sera from patients with other autoimmune-associated (n=22) or inflammatory (n=35) skin diseases. All samples were tested by IIF (EUROIMMUN™ Dermatology Mosaic) and ELISA (EUROIMMUN and MBL). Anti-BP180 is best detected with BP180-antigen dots by IIF (sensitivity: 88%; specificity: 97%). As compared to IIF, the differences with both BP180 ELISA techniques are small though. Likelihood ratios (LRs) for positive and negative test results are >10 and between 0.1 and 0.2, respectively, for all test systems. Detection of anti-BP230 is highly variable (sensitivity range 38-60%; specificity range 83-98%). Only the IIF test reveals a LR for positive test results >10. Since the LRs for a negative test are all ~0.5, negative test results for anti-BP230 antibodies do not help to exclude BP. In conclusion, the multi-parameter IIF test reveals a good diagnostic performance in BP. Since this test simultaneously allows for the detection of anti-Dsg1 and anti-Dsg3 antibodies, involved in pemphigus foliaceus and vulgaris, a single test-incubation may be sufficient to differentiate between the most frequent autoimmune blistering diseases.
authors.affiliation: Laboratory of Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands. jan.damoiseaux@mumc.nl
authors.forename: Jan
authors.initials: J
authors.lastname: Damoiseaux
authors.forename: Margit
authors.initials: M
authors.lastname: van Rijsingen
authors.forename: Nicole
authors.initials: N
authors.lastname: Warnemünde
authors.forename: Cornelia
authors.initials: C
authors.lastname: Dähnrich
authors.forename: Kai
authors.initials: K
authors.lastname: Fechner
authors.forename: Jan Willem Cohen
authors.initials: JW
authors.lastname: Tervaert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood* / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D010391:Pemphigoid, Bullous / Q000097:blood / Q000276:immunology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D001323:Autoantibodies