title: Evaluation of ELISA testing for BP180 and BP230 as a diagnostic modality for bullous pemphigoid: a clinical experience.
abstract: Bullous pemphigoid (BP) is a common autoimmune blistering disorder of the elderly. Several diagnostic modalities are available, including clinical impression, histopathology, direct and indirect immunofluorescence, and enzyme-linked immunosorbent assay (ELISA) detection of pathogenic antibodies. In this study, we aim to examine the utility of the newest test, ELISA, in comparison to the constellation of other tests. We describe our clinical experience in which 170 patients diagnosed with bullous pemphigoid had multiple tests performed. BP180 alone showed a sensitivity of 54 % and specificity of 94 %. The positive predictive value (PPV) is 95 % while the negative predictive value (NPV) is 52 %. BP230 alone yielded a sensitivity of 48 % and specificity of 94 %. The PPV is 94 % and the NPV is 49 %. Using both tests in combination yielded a sensitivity of 66 % and specificity of 89 %. The PPV of at least one of two tests returning positive is 92 % while the NPV of dual negative tests is 58 %. Use of ELISAs for suspected cases of BP are an inadequate standalone test, and are only helpful in making the diagnosis should they return positive. However, they would appear to miss about one-third of cases.
authors.affiliation: Department of Dermatology, UH Case Medical Center, 11100 Euclid Ave, Lakeside Building 3500, Cleveland, OH, 44106, USA. jessejkeller@gmail.com.
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Keller
authors.affiliation: , Pittsburgh, PA, USA.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Kittridge
authors.affiliation: Department of Epidemiology, Case Western Reserve University, 10900 Euclid Ave, Wood Building WG51, Cleveland, OH, 44106, USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Debanne
authors.affiliation: Department of Dermatology, UH Case Medical Center, 11100 Euclid Ave, Lakeside Building 3500, Cleveland, OH, 44106, USA.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Korman
mesh_terms: D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D001324:Autoantigens / Q000032:analysis* / Q000276:immunology; D000071821:Dystonin / Q000032:analysis*; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D006801:Humans; D024041:Non-Fibrillar Collagens / Q000032:analysis*; D010391:Pemphigoid, Bullous / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000097805:Collagen Type XVII
chemical_list: D001323:Autoantibodies; D001324:Autoantigens; D000071821:Dystonin; D024041:Non-Fibrillar Collagens; D000097805:Collagen Type XVII; C486268:DST protein, human
keywords: ELISA; Immunofluorescence; Pemphigoid; Sensitivity; Specificity