IntroductionDiagnosis of bullous pemphigoid (BP) is generally based on clinical criteria, histology [including direct immunofluorescence (DIF) microscopy], detection of circulating IgG autoantibodies by indirect immunofluorescence (IIF) microscopy, and ELISA for BP180 and BP230 antigens. All IgG subclasses have been shown to play a role, but IgG1 and IgG4 may be more important pathogenetically than other subtypes.IIF has a sensitivity of 60–80%. We hypothesized that this relatively low sensitivity may be partly due to undetectably low serum concentrations of circulating IgG autoantibodies or to insufficient reactivity of commercial anti‐human IgG conjugates to minor IgG subclasses such as IgG3 and IgG4. Indeed, we previously showed that amplification of the signal on salt‐split skin by detection of complement‐fixing antibodies resulted in positivity in almost 50% of BP serum samples that had been rated as false negatives by IIF microscopy on oesophagus. Furthermore, Kumar et al. showed increased sensitivity of IIF microscopy using secondary antibodies directed against IgG subclasses. However, in that study, a control group was not included, therefore the specificity of IgG subtype IIF microscopy could not be determined and false‐positive results were possible. Lamb et al. postulated that a sandwich double antibody IIF microscopy using antihuman IgG subclass antibodies would
Clinical & Experimental Dermatology – Wiley
Published: Jan 1, 2018
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