IgA antiepidermal transglutaminase antibodies in dermatitis herpetiformis: a significant but not complete response to a gluten-free diet treatment

Reunala, Timo; Salmi, Teea; Hervonen, Kaisa; Laurila, Kaija; Kautiainen, Hannu; Collin, Pekka; Kaukinen, Katri

doi:10.1111/bjd.13387

Cited by 31 publications

(30 citation statements)

References 11 publications

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“…Interestingly, it has been documented that, in addition to skin, the majority of patients with DH have circulating antibodies against the autoantigen of DH, i.e. TG3 . However, TG3 antibodies also exist occasionally in the serum of patients with CD without any skin symptoms .…”

Section: Diagnosismentioning

confidence: 99%

Dermatitis herpetiformis

Salmi

2019

Clin Exp Dermatol

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Summary Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease (CD), which causes an itching and blistering rash, typically on the elbows, knees and buttocks. DH and CD share a similar genetic background, small bowel mucosal alterations, and an autoimmune response against tissue transglutaminase in the serum and small bowel. DH is typically diagnosed during adulthood, and it is slightly more common among males than females. The incidence of DH seems to be decreasing, in contrast to the detected four‐fold increase in the incidence of CD. In addition to typical clinical picture, diagnosis of DH relies on the demonstration by direct immunofluorescence of pathognomonic granular IgA deposits in the papillary dermis. Circulating tissue transglutaminase antibodies support the diagnosis, but their absence does not exclude DH. Obtainment of small bowel mucosal biopsies is not necessary when DH is diagnosed, but if performed, the majority of patients are found to have villous atrophy, and even those with normal villous architecture evince CD‐type inflammation. The treatment of choice in DH is a strict, life‐long adherence to a gluten‐free diet (GFD). In addition to alleviating the symptoms of DH and healing the small bowel mucosal damage, a GFD increases the quality of life for patients, and decreases the risk for lymphoma in DH. Further, the mortality rate of patients with DH treated with a GFD seems to be lower than that of the general population. However, as changing to a GFD has a rather slow effect on the DH rash, patients with severe skin symptoms should additionally be treated with dapsone medication. This review article is based on a presentation given at the British Society for Medical Dermatology blistering skin diseases meeting 2019.

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Section: Diagnosismentioning

confidence: 99%

Dermatitis herpetiformis

Salmi

2019

Clin Exp Dermatol

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“…Moreover, patients with DH have specific antibodies targeting epidermal transglutaminase 3 (TG3), the dominant autoantigen in DH . These IgA class TG3 antibodies can be found in the serum of the majority of untreated patients . Moreover, the pathognomonic IgA at dermoepidermal junctions also targets TG3 that is localized at this site only in DH …”

Section: Characteristics Duration Of Gluten‐free Diet (Gfd) and Cutmentioning

confidence: 99%

“…untreated patients. 2 Moreover, the pathognomonic IgA at dermoepidermal junctions also targets TG3 that is localized at this site only in DH. 1 The treatment of choice for DH is a lifelong strict glutenfree diet (GFD), during which the dermal IgA disappears slowly.…”

mentioning

confidence: 99%

Disappearance of epidermal transglutaminase and IgA deposits from the papillary dermis of patients with dermatitis herpetiformis after a long-term gluten-free diet

et al. 2018

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“…Some, but not all, of the discrepancies in earlier studies might be explainable by the usage of different methodologies or variable cut-off values. In the majority of the studies TG3 antibody titers have been higher among DH than in celiac disease patients [10,12,[26][27][28] and TG3 antibody positivity more prevalent in DH compared to celiac disease [10,11,25,28], as expected. However, majority of studies focusing on serum TG3 antibodies have been centered around DH patients, and more limited data are available about TG3 antibodies in celiac disease.…”

Section: Discussionmentioning

confidence: 61%