Significantly higher prevalence of circulating bullous pemphigoid-specific IgG autoantibodies in elderly patients with a nonbullous skin disorder

Parkinson disease and multiple sclerosis are not associated with autoantibodies against structural proteins of the dermal-epidermal junction

“…This notion indicates that serum autoreactivity against proteins of the DEJ does not precede the clinical manifestation of BP in patients with PD/MS. Two other risk factors for developing antibodies to BP180 and BP230 – old age and chronic pruritus – have been described; however, these additional risk factors remain disputed . It is feasible that as‐yet‐uncovered environmental factors orchestrate the initiation of the neurological disorders, the onset of pruritus, and the loss of tolerance against BP180 and BP230 in the elderly.…”

“…Two other risk factors for developing antibodies to BP180 and BP230old age and chronic pruritus have been described; however, these additional risk factors remain disputed. 19,21,22 It is feasible that as-yet-uncovered environmental factors orchestrate the initiation of the neurological disorders, the onset of pruritus, and the loss of tolerance against BP180 and BP230 in the elderly. One might speculate that such a factor could be a viral infection that affects both skin and CNS, such as varicella zoster virus.…”

Regulatory T-cell dysfunction induces autoantibodies to bullous pemphigoid antigens in mice and human subjects

“…Autoantibodies to COL17 have been detected in elderly subjects with chronic eczema or pruritus. [40][41][42] Our recent study using fulllength COL17 ELISA revealed that sera from noninflammatory (lacking itchy edematous erythema) cases of BP tend to react to COL17 regions other than the NC16 A domain. 43 Recently, dipeptidyl peptidase IV inhibitors, which are widely used for treatment of type 2 diabetes, have received attention as a possible causative drug of BP.…”

Biomarkers related to bullous pemphigoid activity and outcome

“…Actually, autoantibodies against BP180 are not specific to BP, as serum autoantibodies against the NC16A domain of BP180 are also detected by ELISA in almost 33% of patients with mucous membrane pemphigoid . The differential diagnosis between BP and mucous membrane pemphigoid is sometimes difficult, and classification relies on both clinical signs, that is, the presence of obvious scarring tendency of involved mucosal sites and limited skin involvement, and on immunological characterization of circulating autoantibodies . In this line, a multivariant ELISA for the simultaneous detection of IgG autoantibodies against major autoimmune bullous disease target antigens was established to help for the serologic diagnosis of almost all pemphigus and most pemphigoid disorders …”