IGG4 FITC, IFA

USEFUL FOR 

Confirming a diagnosis of pemphigoid, pemphigus, epidermolysis bullosa acquisita, or bullous lupus erythematosus

METHOD NAME 

Indirect Immunofluorescence

 

REPORTING NAME 

Cutaneous Immfluor. Ab, S (IgG)

ALIASES 

Basement Membrane Antibodies

Bullous Pemphigoid

Cicatricial Pemphigoid

CII, Serum

Circulating IgG Basement Membrane Zone Antibody

Circulating Intercellular Ab Study

Epidermal Cell Surface Antibody

Epidermal Fluorescence Antibody

Epidermolysis Bullosa Acquisita

Epithelial Antibody

Herpes gestationis

IMF - Epidermal Fluorescent Ab

Indirect Immunofluorescence

Intercellular Substance Antibody

Pemphigoid

Pemphigus

Skin Basement Membrane Antibodies

Split-Skin Assay

Lupus Erythematosus (LE)

Bullous Lupus Erythematosus

SPECIMEN TYPE 

SPECIMEN REQUIRED 

Collection Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 2 mL

SPECIMEN MINIMUM VOLUME 

0.5 mL

USEFUL FOR 

Confirming a diagnosis of pemphigoid, pemphigus, epidermolysis bullosa acquisita, or bullous lupus erythematosus

CLINICAL INFORMATION 

IgG anti-basement membrane zone (BMZ) antibodies are produced by patients with pemphigoid. In most patients with bullous pemphigoid, serum contains IgG anti-BMZ antibodies, while in cicatricial pemphigoid circulating IgG anti-BMZ antibodies are found in a minority of cases. Sensitivity of detection of anti-BMZ antibodies is increased when serum is tested using sodium chloride-split primate skin as substrate.

 

Circulating IgG anti-BMZ antibodies are also detected in patients with epidermolysis bullosa acquisita and bullous eruption of lupus erythematosus.

 

IgG anti-cell surface (CS) antibodies are produced by patients with pemphigus. The titer of anti-CS antibodies generally correlates with disease activity of pemphigus.

REFERENCE VALUES 

Report includes presence and titer of circulating antibodies. If serum contains basement zone (BMZ) antibodies on split-skin substrate, patterns will be reported as:

1) Epidermal pattern, consistent with pemphigoid

2) Dermal pattern, consistent with epidermolysis bullosa acquisita

 

Negative in normal individuals

INTERPRETATION 

Indirect immunofluorescence (IF) testing may be diagnostic when histologic or direct IF studies are only suggestive, nonspecific, or negative.

 

Anti-cell surface (CS) antibodies correlate with a diagnosis of pemphigus.

 

Anti-basement membrane zone (BMZ) antibodies correlate with a diagnosis of bullous pemphigoid, cicatricial pemphigoid, epidermolysis bullosa acquisita (EBA), or bullous eruption of lupus erythematosus (LE).

 

If serum contains anti-BMZ antibodies, the pattern of fluorescence on sodium chloride (NaCl)-split skin substrate helps distinguish pemphigoid from EBA and bullous LE. Staining of the roof (epidermal side) or both epidermal and dermal sides of NaCl-split skin correlates with the diagnosis of pemphigoid, while fluorescence localized only to the dermal side of the split-skin substrate correlates with either EBA or bullous LE.