Charneux et al raise a practice gap regarding the appropriateness and effectiveness of ELISAs for confirming the initial diagnosis of BP, the most common autoimmune blistering skin disease. The diagnosis of BP is traditionally based on a combination of evidence: tense bullae on normal-appearing skin or erythematous and urticarial plaques on clinical morphologic examination, subepidermal blister with eosinophil infiltration on histopathologic examination, linear IgG or C3 deposits along the epidermal basement membrane of perilesional skin on direct immunofluorescence microscopy, and serum IgG autoantibodies binding to the epidermal side of artificially split skin through 1.0M sodium chloride on indirect IF microscopy.
Chan LS. ELISA Instead of Indirect IF in Patients With BPComment on “Usefulness of BP230 and BP180-NC16a Enzyme-Linked Immunosorbent Assays in the Initial Diagnosis of Bullous Pemphigoid”. Arch Dermatol. 2011;147(3):291-292. doi:10.1001/archdermatol.2011.24