Serological Insights into Bullous Pemphigoid: Comparative Diagnostic Performance and Their Association with Clinical Severity
Mohan Shendre, B Tejashwini, Chanabasappa Mendagudli, HR Sushma, Mitaxari Hugar, Shivakumar BelurAbstract
Background:
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease caused by autoantibodies targeting BP180 and BP230. We evaluated the diagnostic performance of anti-BP180-NC16A and anti-BP230 enzyme-linked immunosorbent assay (ELISA) and their relationship with disease severity in an Indian population.
Aim:
The aim is to compare the diagnostic performance of anti-BP180-NC16A and anti-BP230 ELISA in BP and evaluate their correlation with disease severity.
Materials and Methods:
This case–control study included 21 BP patients confirmed by clinical features, histopathology, and direct immunofluorescence, and 21 age- and sex-matched healthy controls. Serum IgG antibodies against BP180 and BP230 were measured using EUROIMMUN ELISA kits. Disease severity was assessed using the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). Statistical analyses included the Mann–Whitney
Results:
Anti-BP180-NC16A levels were significantly elevated in BP patients. Anti-BP180 ELISA demonstrated 57.1% sensitivity and 95.2% specificity. Anti-BP230 levels were also elevated with 38.1% sensitivity and 100% specificity. Anti-BP180 showed significantly greater sensitivity than anti-BP230. Disease severity: 61.9% mild, 23.8% moderate, and 14.3% severe. Higher BP180 levels trended toward greater severity, though not statistically significant. A moderate positive correlation existed between BP180 and BP230 levels.
Conclusion:
Anti-BP180-NC16A ELISA demonstrated superior diagnostic sensitivity while maintaining high specificity. Anti-BP180 should serve as the primary serological marker, with anti-BP230 as a useful adjunct to improve diagnostic yield. In addition, BP180 antibody levels showed a positive trend toward correlation with disease severity ABSIS score, reflecting clinical disease activity and aiding disease monitoring.