Background: Dermatitis herpetiformis (DH) is a rare gluten-induced skin disorder characterized predominantly by IgA autoantibodies against endomysium, tissue transglutaminase (TG2/tTG), epidermal transglutaminase (TG3/eTG), and deamidated gliadin. To date, circulating autoantibody reactivity has not been systematically described. Objective: Characterization of serum reactivities in DH. Methods: This multicenter international study analyzed sera from 242 DH patients taken at the time of initial diagnosis. DH-specific IgA and IgG serum autoantibodies were analyzed by indirect immunofluorescence (IF) on monkey esophagus, and by enzyme-linked immune sorbent assay (ELISA) based on recombinant TG2/tTG, TG3/eTG, and deamidated gliadin (GAF3X). Results: IgA indirect IF microscopy on monkey esophagus revealed the highest reactivity (84.3%; specificity 100%) followed by IgA TG2/tTG ELISA (78.5%, 99.0%), IgA TG3/eTG ELISA (72.7%, 95.0%), and IgA GAF3X ELISA (69.0%, 98.5%). Conclusion: Serum IgA and IgG autoantibodies against endomysium, TG2/tTG, TG3/eTG, and deamidated gliadin are highly prevalent in DH. Indirect IF microscopy on monkey esophagus (IgA) provides the highest diagnostic accuracy that can be further enhanced by 3.5% when combined with IgA TG2/tTG ELISA.
Serum reactivity in dermatitis herpetiformis: an international multicenter study / Katharina Boch, Florian Heck, Christoph M Hammers, Emiliano Antiga, Marzia Caproni, David Juhl, Stephanie Goletz, Orsolya N Horváth, Laura Huilaja, Stanislav Khil'chenko, Christian Sina, Kaisa Tasanen, Snejina Vassileva, Wolfgang Schlumberger, Detlef Zillikens, Martin Shahid, Kossara Drenovska, John J Zone, Kamilla Koszorú, Kai Fechner, Cornelia Dähnrich, Inke R König, Enno Schmidt. - In: CLINICAL AND EXPERIMENTAL DERMATOLOGY. - ISSN 0307-6938. - ELETTRONICO. - (2023), pp. 0-0. [10.1093/ced/llad319]
Serum reactivity in dermatitis herpetiformis: an international multicenter study
Emiliano Antiga;Marzia Caproni;
2023
Abstract
Background: Dermatitis herpetiformis (DH) is a rare gluten-induced skin disorder characterized predominantly by IgA autoantibodies against endomysium, tissue transglutaminase (TG2/tTG), epidermal transglutaminase (TG3/eTG), and deamidated gliadin. To date, circulating autoantibody reactivity has not been systematically described. Objective: Characterization of serum reactivities in DH. Methods: This multicenter international study analyzed sera from 242 DH patients taken at the time of initial diagnosis. DH-specific IgA and IgG serum autoantibodies were analyzed by indirect immunofluorescence (IF) on monkey esophagus, and by enzyme-linked immune sorbent assay (ELISA) based on recombinant TG2/tTG, TG3/eTG, and deamidated gliadin (GAF3X). Results: IgA indirect IF microscopy on monkey esophagus revealed the highest reactivity (84.3%; specificity 100%) followed by IgA TG2/tTG ELISA (78.5%, 99.0%), IgA TG3/eTG ELISA (72.7%, 95.0%), and IgA GAF3X ELISA (69.0%, 98.5%). Conclusion: Serum IgA and IgG autoantibodies against endomysium, TG2/tTG, TG3/eTG, and deamidated gliadin are highly prevalent in DH. Indirect IF microscopy on monkey esophagus (IgA) provides the highest diagnostic accuracy that can be further enhanced by 3.5% when combined with IgA TG2/tTG ELISA.
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