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Jankaskova, J.; Horvath, O. N.; Varga, R.; Arenberger, P.; Schmidt, E.; Ruzicka, T.; Sardy, M. (2018): Increased sensitivity and high specificity of indirect immunofluorescence in detecting IgG subclasses for diagnosis of bullous pemphigoid. In: Clinical and Experimental Dermatology, Vol. 43, No. 3: pp. 248-253
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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 IgG(1), IgG(3) and IgG(4) autoantibodies. Results: The sensitivities of IIF in detecting IgG(1), IgG(3), IgG(4) 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 IgG(1) and IgG(4)) autoantibodies by IIF on monkey oesophagus can significantly improve diagnostic performance of IIF microscopy for diagnosis of BP.