title: Comparison of desmoglein 1 and 3 enzyme-linked immunosorbent assay and direct immunofluorescence for evaluation of immunological remission in pemphigus vulgaris.
abstract: BACKGROUND
  Drug withdrawal is the ultimate goal in the management of patients with pemphigus. Direct immunofluorescence (DIF) has long been considered the gold-standard test to predict immunological remission in pemphigus vulgaris (PV); however, there have been no comparisons between DIF and antidesmoglein (anti-Dsg) ELISA.
  
  
  OBJECTIVE
  To compare anti-Dsg ELISA with DIF in patients with PV for evaluation of immunological remission.
  
  
  METHODS
  The study enrolled 46 patients with PV who had absence of any lesion, and had a daily prednisolone dosage of ≤ 10 mg without adjuvant drug treatment in the preceding 6 months. Biopsy specimens were taken from patients and processed for DIF. Intercellular deposition of IgG and/or C3 was considered positive. Serum samples were also collected for anti-Dsg1 and anti-Dsg3 ELISA, and an ELISA index value of > 20.0 was considered positive.
  
  
  RESULTS
  DIF and anti-Dsg ELISA were positive for 11 (23.9%) and 18 patients (39.1%), respectively. Anti-Dsg ELISA had a sensitivity of 100%, a specificity of 80%, a positive predictive value of 61.1% and a negative predictive value of 100%.
  
  
  CONCLUSIONS
  The high sensitivity of anti-Dsg ELISA proves that this simple serological test is a good substitute for DIF for evaluation of immunological remission in PV. As none of the DIF-positive patients was anti-Dsg-negative, it is possible that during the course of immunological remission, results for DIF may become negative before the results for Dsg ELISA do so.
authors.affiliation: Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Daneshpazhooh
authors.forename: K
authors.initials: K
authors.lastname: Kamyab
authors.forename: M-S
authors.initials: MS
authors.lastname: Kalantari
authors.forename: K
authors.initials: K
authors.lastname: Balighi
authors.forename: Z S
authors.initials: ZS
authors.lastname: Naraghi
authors.forename: S
authors.initials: S
authors.lastname: Shamohammadi
authors.forename: S M-A
authors.initials: SM
authors.lastname: Mortazavizadeh
authors.forename: A
authors.initials: A
authors.lastname: Ramezani
authors.forename: C
authors.initials: C
authors.lastname: Chams-Davatchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood* / Q000276:immunology; D051183:Desmoglein 1 / Q000276:immunology*; D051184:Desmoglein 3 / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000188:drug therapy / Q000276:immunology*; D011237:Predictive Value of Tests; D011239:Prednisolone / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D051183:Desmoglein 1; D051184:Desmoglein 3; D005938:Glucocorticoids; D007074:Immunoglobulin G; D011239:Prednisolone