The following is a summary of “Anti-BP230 IgE autoantibodies in bullous pemphigoid intraindividually correlate with disease activity,” published in the May 2024 issue of Dermatology by Emtenani, et al.

Bullous pemphigoid (BP), the most prevalent subepidermal autoimmune blistering disease, is characterized by IgG autoantibodies targeting hemidesmosomal proteins BP180 (type XVII collagen) and BP230, with a predominance of skin lesions. While studies had extensively explored anti-BP180 IgE in both patients and experimental models, data on anti-BP230 IgE were limited. For a study, researchers sought to evaluate anti-BP230 IgE levels using ELISA in BP sera and to correlate these levels with disease severity and clinical characteristics.

BP sera were subjected to anti-BP230 IgE ELISA and Western blotting against human BP230 fragments.

Of the 154 BP sera analyzed, 36 (23%) tested positive for anti-BP230 IgE. Anti-BP230 IgE levels did not correlate with the clinical phenotype or disease activity per se. However, they were significantly associated with disease activity within individuals during the disease course. Furthermore, a significant correlation was observed between anti-BP230 IgE and total IgE levels. Interestingly, anti-BP230 IgG correlated interindividually with disease activity. Western blotting revealed that the C-terminal domain of BP230 fragments (C2; amino acids 2024–2349 and C3; amino acids 2326–2649) provided the most effective serological assay for anti-BP230 IgE detection.

Although the detection of serum anti-BP230 IgE may not be diagnostically significant, it could be relevant for therapeutic decisions, such as anti-IgE-directed treatment, especially in patients with severe disease lacking IgG reactivity in BP180- or BP230-specific ELISA. Hence, IgE immunoblotting was recommended as a complementary tool for optimal serological diagnosis in patients with BP.

Reference: sciencedirect.com/science/article/pii/S0923181124000550