title: Three Cases of Bullous Pemphigoid Associated with Dipeptidyl Peptidase-4 Inhibitors - One due to Linagliptin.
abstract: BACKGROUND
  Bullous pemphigoid (BP) is an acquired subepidermal autoimmune blistering disease in which there are humoral and cellular responses against the BP180 and BP230 antigens. Dipeptidyl peptidase (DPP)-4 inhibitors enhance endogenous glucagon peptide-1 and glucose-dependent insulinotropic polypeptide secretion with food intake, which leads to insulin secretion, as well as to the reduction of glucagon secretion. Recently, several cases of DPP-4 inhibitor-associated BP have been reported.
  
  
  OBJECTIVE
  To report 3 cases of DPP-4 inhibitor-associated BP, one of which is due to linagliptin use, as well as to review all currently published cases of DPP-4 inhibitor-associated BP.
  
  
  METHODS
  Three patients diagnosed with BP at our department showed a clear temporal relationship between the introduction of DPP-4 for the treatment of diabetes and the onset of BP. One case was due to linagliptin use, while the other 2 cases were due to an association with vildagliptin-metformin use.
  
  
  CONCLUSIONS
  This is the first report of linagliptin-associated BP. Furthermore, 2 other cases of vildagliptin-associated BP are reported.
authors.affiliation: Department of Dermatology, Hospital Universitario Virgen Macarena, Seville, Spain.
authors.forename: Francisco Manuel Ildefonso
authors.initials: FM
authors.lastname: Mendonça
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Martín-Gutierrez
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Ríos-Martín
authors.forename: Francisco
authors.initials: F
authors.lastname: Camacho-Martinez
mesh_terms: D000218:Adamantane / Q000009:adverse effects / Q000031:analogs & derivatives*; D000368:Aged; D000369:Aged, 80 and over; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology*; D005260:Female; D006801:Humans; D000069476:Linagliptin / Q000009:adverse effects*; D008297:Male; D009570:Nitriles / Q000009:adverse effects*; D010391:Pemphigoid, Bullous / Q000139:chemically induced*; D011759:Pyrrolidines / Q000009:adverse effects*; D000077597:Vildagliptin
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D009570:Nitriles; D011759:Pyrrolidines; D000069476:Linagliptin; D000077597:Vildagliptin; D000218:Adamantane