Drug-induced linear IgA disease: target antigens are heterogeneous

Abstract

No information is available concerning the target antigen(s) in drug-induced linear IgA disease. The purpose of this study was to define better drug-induced linear IgA disease by studying its immunopathological, immunoultrastructural and immunochemical characteristics in three patients. In the first patient, IgA deposits were seen in the lamina lucida. In the second and the third patients, IgA deposits were seen on each side of the lamina densa. Immunoblotting of the first patient's serum showed that IgA reacted with a protein of 230 kDa similar to the bullous pemphigoid-associated antigen 1 (BPAG 1). The second patient's serum did not react with specific bands. In the third patient IgA antibodies reacted with a protein of 97 kDa on epidermal extracts. Our findings suggest that, as in idiopathic forms, the target antigen is not unique in drug-induced linear IgA disease. In some patients, drug-induced linear IgA disease may represent an IgA class response to the BPAG 1.

Vancomycin-induced Linear IgA Bullous Dermatosis: A Case Report and Review of the Literature

“…In the case of druginduced LABD, there are far fewer cases that have been reported, and thus it has been harder to characterize the target antigen involved. Two studies have found antibodies to the 230kD antigen, the 97kD antigen, and type-VII collagen in nonvancomycin drug-induced LABD 14,15 , and one study reported two patients with vancomycin-induced LABD with autoantibodies against BP180 and LAD 285 10 . The severity of the reaction does not appear to correlate with serum vancomycin levels.…”

Childhood linear IgA bullous disease induced by trimethoprim-sulfamethoxazole

“…3,5,6 However, mucosal lesions can be noted in up to 40% of drug-induced cases, which is still lower than the 80% involvement observed in the classical LABD. 7,11 Childhood LABD has been mostly associated with infections or drug ingestion and rarely with other conditions such as ulcerative colitis and autoimmune lymphoproliferative disease. 2,9 The most frequently reported drugs that can induce LABD in adults are antibiotics such as vancomycin, penicillin G, ampicillin, cefamandole, TMP-SMX, rifampin and sulfisoxazole, NSAID such as piroxicam, naproxen and diclofenac, interferon-gamma, interleukin-2, phenytoin, amiodarone, captopril, iodine contrast agent, somatostatin, lithium, furosemide and cyclosporine.…”

“…medical literature. 3,10,11 The only pediatric possible TMP-SMX-induced LABD was a 5-year-old child presenting acute lymphoblastic leukemia (ALL) in remission who received prophylactic treatment with TMP-SMX. 3 Our patient is the first case of LABD induced by TMP-SMX that was confirmed by a rechallenge.…”

Drug-induced linear IgA bullous dermatosis after discontinuation of cefuroxime axetil treatment

“…Autoantibodies in patients with drug-induced LABD are directed to the same heterogeneous group of proteins as in the idiopathic form. 4 Until now, there have not been identified typical clinical, histologic or immunologic features of drug-induced variant of this disease. However some studies have reported that when compared to idiopathic subtype in drug-induced LABD:…”

“…It may cause breaking the self-tolerance to these native antigens. 4,7 Recent study, that reviewed all reported cases of druginduced LABD till December 2010 showed, that although in the majority of cases the suspected offending drug was withdrawn, spontaneous resolution with any additional systemic therapy was reached in less than 50% of cases. Thus it is likely that an amplification of the immunological signal occurred in some cases of drug-induced LABD, resulting in a self-maintaining immune response.…”