title: Comparative study of direct and indirect immunofluorescence and of bullous pemphigoid 180 and 230 enzyme-linked immunosorbent assays for diagnosis of bullous pemphigoid.
abstract: BACKGROUND
  Direct immunofluorescence (DIF), indirect immunofluorescence (IIF), and enzyme-linked immunosorbent assay (ELISA) are used for the laboratory diagnosis of bullous pemphigoid (BP).
  
  
  OBJECTIVE
  The diagnostic value of DIF and IIF on rabbit and monkey esophagus or human salt-split skin and commercial ELISAs was assessed.
  
  
  METHODS
  This was a single-center retrospective study where 313 patients with BP were compared with 488 control subjects.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The retrospective nature of study was a limitation. Correlation of diagnostic data with clinical manifestations or disease course was not possible.
  
  
  CONCLUSIONS
  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.
authors: Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany. Electronic address: miklos.sardy@med.uni-muenchen.de.
authors: Miklós
authors: M
authors: Sárdy
authors: Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany; Department of Dermatology, University of L'Aquila, L'Aquila, Italy.
authors: Dimitra
authors: D
authors: Kostaki
authors: Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany.
authors: Rita
authors: R
authors: Varga
authors: Department of Dermatology, University of L'Aquila, L'Aquila, Italy.
authors: Ketty
authors: K
authors: Peris
authors: Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany.
authors: Thomas
authors: T
authors: Ruzicka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001324:Autoantigens / Q000032:analysis*; D002352:Carrier Proteins / Q000032:analysis*; D002648:Child; D003598:Cytoskeletal Proteins / Q000032:analysis*; D000071821:Dystonin; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D008297:Male; D008875:Middle Aged; D009419:Nerve Tissue Proteins / Q000032:analysis*; D024041:Non-Fibrillar Collagens / Q000032:analysis*; D010391:Pemphigoid, Bullous / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult; D000097805:Collagen Type XVII
chemical_list: D001324:Autoantigens; D002352:Carrier Proteins; D003598:Cytoskeletal Proteins; D000071821:Dystonin; D009419:Nerve Tissue Proteins; D024041:Non-Fibrillar Collagens; D000097805:Collagen Type XVII; C486268:DST protein, human
keywords: BMZ; BP; CI; DIF; ELISA; IIF; basement membrane zone; bullous pemphigoid; bullous pemphigoid 180; bullous pemphigoid 230; collagen XVII; confidence interval; diagnostics; direct immunofluorescence; enzyme-linked immunosorbent assay; esophagus; immunofluorescence; indirect immunofluorescence; sensitivity; specificity