Serologic diagnosis of autoimmune blistering disease (AIBD) usually follows a sophisticated multistep algorithm.
We sought validation of a multivariant enzyme-linked immunosorbent assay (ELISA) in the routine diagnosis of AIBD.
The multivariant ELISA comprising 6 recombinant immunodominant forms of major AIBD target antigens, ie, desmoglein 1, desmoglein 3, envoplakin, BP180, BP230, and type VII collagen was applied in: (1) a cohort of well-characterized AIBD (n = 173) and control sera (n = 130), (2) a prospective multicenter study with 204 sera from patients with newly diagnosed AIBD with positive direct immunofluorescence microscopy, and (3) a prospective monocenter study with 292 consecutive sera from patients with clinical suspicion of AIBD in comparison with the conventional multistep diagnostic algorithm.
Concordant results in the multivariant ELISA compared with direct immunofluorescence microscopy were seen in 94% of patients with pemphigus and 71% of patients with pemphigoid (Cohen κ value, 0.95 and 0.66) and with the conventional multistep diagnostic approach in 91% of patients with pemphigus and 88% of patients with bullous pemphigoid and 93% of autoantibody-negative sera (Cohen κ, 0.95, 0.84, and 0.78).
IgA autoantibodies and less common target antigens were not analyzed.
The multivariant ELISA is a practical, highly standardized, and widely available novel diagnostic tool for the routine diagnosis of AIBD.Le texte complet de cet article est disponible en PDF.
Key words : autoantibody, blistering, bullous pemphigoid, epidermolysis bullosa acquisita, pemphigus
Abbreviations used : AIBD, ELISA, IF
| Drs van Beek and Dähnrich contributed equally to this article.
| Supported by the Schleswig-Holstein Cluster of Excellence Inflammation at Interfaces (DFG EXC306/2), the Clinical Research Unit 303 Pemphigoid Diseases (SCHM 1686/7-1, BE 5866/1-1), and the Australasian Blistering Diseases Foundation (ABDF2013/HYCZNCMKDM/1).
| Disclosure: Drs Schmidt and Zillikens have a scientific collaboration with Euroimmun. Drs Dähnrich and Johannsen are employed at Euroimmun. Dr Dähnrich is a shareholder of Euroimmun. Dr Schlumberger is vice-president and shareholder of Euroimmun. Drs van Beek, Lemcke, Goletz, Hübner, Di Zenzo, Dmochowski, Drenovska, Geller, Horn, Kowalewski, Medenica, Murrell, Patsatsi, Uzun, and Vassileva have no conflicts of interest to declare.
| Supplemental material is available at www.jaad.org/.