Autoantibody Detection for Diagnosis in Direct Immunofluorescence-Negative Mucous Membrane Pemphigoid

Purpose To assess whether a panel of serum pemphigoid autoantibody tests could be used to confirm an immunopathologic diagnosis mucous membrane (MMP) in direct immunofluorescent negative (DIF–) MMP patients. Design Prospective cross-sectional study. Participants Seventy-six patients with multisite 45 matched control participants. Methods Enzyme-linked immunosorbent assays (ELISAs) for BP180 and BP230 (MBL International), immunoglobulin A (IgA) G indirect immunofluorescence (IIF) on human salt-split skin the keratinocyte footprint assay anti–laminin 332 antibodies. Main Outcome Measures Sensitivity specificity detection significant differences individual test combinations involving different sites. Results All DIF– (24/73 [31.8%]) had either ocular-only disease or ocular involvement disease. Serum autoantibodies were detected 29 76 (38.2%) compared 3 participants (6.7%). Autoantibody reactivity by any 1 more was present 6 24 (25%) 22 49 DIF positive (DIF+) (44.9%). Ocular-only not significantly combination participants, whereas differed ELISA 7 combinations. By contrast, DIF+ nonocular patients, all tests, apart from IgA IIF, those For entire cohort, sensitivity low, having maximum 21.05% but increasing 38.16% optimal combination. Disease activity associated strongly serologic findings. Conclusions Pemphigoid did provide evidence showed limited value The requirement confirmation is inappropriate resulting missed diagnoses, delayed therapy, poor outcomes. Alternative diagnostic criteria are required exclude other causes scarring conjunctivitis until sensitive specific become available.