RESUMO
BACKGROUND: Indirect immunofluorescence (IIF) microscopy on monkey oesophagus is an important assay for the diagnosis of bullous pemphigoid (BP). Its relatively low sensitivity (60-80%) may be partly due to insufficient detection of minor IgG subclasses. AIM: To determine the operating characteristics of an IgG subclass in IIF. METHODS: We designed a retrospective, dual-centre, controlled cohort study on sera from 64 BP sera that had been rated as false negatives by traditional IIF microscopy, and assessed circulating IgG1 , IgG3 and IgG4 autoantibodies. RESULTS: The sensitivities of IIF in detecting IgG1 , IgG3 , IgG4 and all three in combination were 45.3%, 18.8%, 32.8% and 48.4%, respectively. Specificities were > 97%. CONCLUSION: Detection of IgG subclass (especially IgG1 and IgG4 ) autoantibodies by IIF on monkey oesophagus can significantly improve diagnostic performance of IIF microscopy for diagnosis of BP.
Assuntos
Técnica Indireta de Fluorescência para Anticorpo , Imunoglobulina G/classificação , Penfigoide Bolhoso/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Ensaio de Imunoadsorção Enzimática , Esôfago/imunologia , Reações Falso-Negativas , Feminino , Haplorrinos , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Penfigoide Bolhoso/diagnóstico , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The incidence and thereby also the relevance of pemphigoid diseases have significantly increased in elderly patients. METHODS: The clinical features, diagnostic workup, and therapy of pemphigoid diseases based on the recently published German guidelines and expert opinions are described. RESULTS: The diagnosis is based on medical history, clinical manifestations, histopathology, and autoimmune serology. Treatment options depend on the diagnosis and disease severity. Both local and systemic immunosuppressive or immunomodulatory strategies have been proven to be effective. CONCLUSIONS: Chronic, itchy, inflammatory skin disorders in elderly patients are generally suspicious for pemphigoid diseases. The prognosis is usually good. For decisions about (local or systemic) immunosuppressive therapy, gerontological aspects should be taken into consideration.
