In vivo analysis of IgE autoantibodies in bullous pemphigoid: A study of 100 cases

•IgE autoantibodies may be involved in the pathogenesis of bullous pemphigoid (BP).•However, in vivo studies on IgE deposition with large numbers are lacking.•18% of bullous pemphigoid patients showed in vivo IgE deposition.•In vivo IgE deposition may be associated with distinct clinical features in BP.

BackgroundBullous pemphigoid (BP) is an acquired autoimmune blistering disease characterized by subepidermal blister formation, in vivo linear deposition of immunoglobulin G (IgG) and complements at the dermal–epidermal junction (DEJ). The circulating IgG autoantibodies are directed against two epidermal hemidesmosomal glycoproteins: BP180, also known as type XVII collagen (COL17), and BP230. In addition, recent studies have shown that IgE autoantibodies may be involved in the pathogenesis of BP, although in vivo IgE deposition in lesional skin has not been fully characterized in large numbers of BP patients.ObjectiveThis study investigated the incidence of in vivo deposition of IgE autoantibodies at the DEJ in lesional skin from a large number of BP patients.MethodsPeri-lesional skin samples from 100 patients who met the clinical and histopathological criteria for BP were investigated by direct immunofluorescence for the deposition of autoantibodies and complement. Patients’ sera were also investigated by enzyme-linked immunosorbent assay and indirect immunofluorescence.Results18% of BP patients were found to show IgE deposition at the DEJ. Disease severity, clinical course and outcome did not differ between IgE-positive and IgE-negative patients. In 3 IgE-positive cases, IgG was undetectable in vivo, and these cases showed atypical manifestations.ConclusionThe results of in vivo IgE deposition may not be useful in predicting the disease course of BP, although predominant IgE deposition could alter the pattern of clinical manifestations.