Spectrum of autoimmune bullous diseases among children in Kuwait

Nanda, Arti; Lazarevic, Viktor; Rajy, Jihan M.; Almasry, Iman; Al‐Sabah, Humoud; AlLafi, Atlal

doi:10.1111/pde.14368

Cited by 9 publications

(17 citation statements)

References 22 publications

(29 reference statements)

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“…Bullous pemphigoid (BP) is a cutaneous autoimmune blistering disorder with a high incidence, ranging from 2.5 to 42.8 cases per million per year in Europe and 2.6 to 7.5 cases per million in Asia, [1][2][3][4] and an overall 1-year mortality rate of 23.5% is noted in patients with BP (range 6%-41%). 5 BP mainly affects elderly people and is characterized by the presence of circulating IgG autoantibodies that recognize self-antigens BP180 (BPAG2) and BP230 (BPAG1) of the basement membrane zone (BMZ), which leads to the separation of the epidermis and dermis.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Clinical Characteristics of Dipeptidyl Peptidase-4 Inhibitor–Induced Bullous Pemphigoid

Sun

Wang

et al. 2021

Ann Pharmacother

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Objective To analyze and discuss the clinical characteristics of dipeptidyl peptidase-4 inhibitor (DPP4i)-induced bullous pemphigoid (BP). Data Sources We collected case reports of DPP4i-induced BP by searching databases from 2006 to mid-May 2021, as a retrospective analysis. Study Selection and Data Extraction Relevant case reports and case analyses of DPP4i-induced BP were included. Data Synthesis The median time of symptom onset was 9 months (range 0.5-59 months). BP most often occurred in patients receiving vildagliptin (52.63%) followed by linagliptin (27.19%) and sitagliptin (17.54%). Tense bullae and blisters (85.51%) and erythema (82.61%) on the extremities and trunk were the most common presenting symptoms. In total, 64.06% of BP patients were anti-BP180 autoantibody positive, 58.97% were BP180NC16a autoantibody positive, and 31.25% were anti-BP230 autoantibody positive. Skin biopsy revealed subepidermal bulla eosinophil infiltration in 93.85% of BP patients, lymphocyte infiltration in 56.93%, and neutrophil infiltration in 44.62%. Direct immunofluorescence was positive in 98.94% of BP patients with linear deposition of IgG (97.80%) and/or complement C3 (98.94%) along the basement membrane zone. Indirect immunofluorescence was positive in 87.88% of BP patients. Complete remission of BP was achieved in 83.64% of patients on DPP4i withdrawal and after 4 months (range 0.13-72 months) of follow-up. Relevance to Patient Care and Clinical Practice This review analyzes and discusses the clinical characteristics of DPP4i-induced BP and provides a reference for the safe and reasonable clinical application of DPP4i. Conclusions DPP4i drugs are related to the occurrence of BP in diabetic patients, especially elderly men taking vildagliptin.

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Section: Introductionmentioning

confidence: 99%

Analysis of the Clinical Characteristics of Dipeptidyl Peptidase-4 Inhibitor–Induced Bullous Pemphigoid

Sun

Wang

et al. 2021

Ann Pharmacother

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“…Sulfamethoxypyridazine and sulfasalazine are sulfonamides that have been reported as effective treatments for LAD, with minimal risk [ 6 , 28 ]. Since dapsone and some sulfa drugs are difficult to obtain in countries such as China, oral sulfasalazine at 40–60 mg/kg/day was given to a 17-year-old boy in China along with oral sodium bicarbonate to prevent the formation of urinary tract crystals for two months [ 6 ].…”

Section: Resultsmentioning

confidence: 99%

“…Since dapsone and some sulfa drugs are difficult to obtain in countries such as China, oral sulfasalazine at 40–60 mg/kg/day was given to a 17-year-old boy in China along with oral sodium bicarbonate to prevent the formation of urinary tract crystals for two months [ 6 ]. Another study in Kuwait transitioned a 7-year-old from dapsone to sulfamethoxypyridazine (250 mg/day to 1 g/day for 60 months) because of persistent hemolysis [ 28 ]. No relapses or side effects were reported in both patients.…”

Section: Resultsmentioning

confidence: 99%

“…IVIg is used in immune-mediated diseases, including autoimmune dermatologic conditions. Regarding LAD, three studies used IVIg either as a primary or adjunct treatment if the disease was severe and/or therapy-resistant [ 12 , 19 , 28 ]. The dose used was 2 g/kg over a few days, without relapses.…”

Section: Resultsmentioning

confidence: 99%

“…Systemic Corticosteroids Systemic corticosteroids were commonly paired with dapsone or IVIg in the treatment of LAD. Prednisolone was used in pediatric patients at a dose of 0.5-1 mg/kg/day, while prednisolone or prednisone were used at doses of up to 1 mg/kg/day in adults [16,19,25,28,29]. In Nanda et al, prednisolone in tapering doses was added to the dapsone regimen if response was slow.…”

Section: Topical Corticosteroidsmentioning

confidence: 99%

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Updates in the Diagnosis and Management of Linear IgA Disease: A Systematic Review

2021

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Background and Objectives: Linear IgA disease (LAD) is a rare autoimmune blistering disease with linear IgA deposits along the basement membrane zone. Direct immunofluorescence remains the gold standard for diagnosis, but other diagnostic measures reported in recent literature have proven useful in the setting of inconclusive preliminary results. Dapsone is a commonly used treatment, but many therapeutic agents have emerged in recent years. The objective of this study is to provide a comprehensive overview of updates on the diagnosis and management of LAD. Materials and Methods: A literature search was conducted from May to June of 2021 for articles published in the last 5 years that were related to the diagnosis and management of LAD. Results: False-negative results in cases of drug-induced LAD and the presence of IgG and IgM antibodies on immunofluorescence studies were reported. Serration pattern analysis has been reported to be useful in distinguishing LAD from sublamina densa-type LAD. Rituximab, omalizumab, etanercept, IVIg, sulfonamides, topical corticosteroids, and others have been used successfully in adult and pediatric patients with varying disease severity. Topical corticosteroids were preferred for pediatric patients while rituximab and IVIg were used in adults with recalcitrant LAD. Sulfonamides were utilized in places without access to dapsone. Conclusion: In cases where preliminary biopsy results are negative and clinical suspicion is high, repeat biopsy and additional diagnostic studies should be used. Patient factors such as age, medical comorbidities, and disease severity play a role in therapeutic selection.

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Autoimmune Bullous Diseases in Childhood

Bolling

Meijer

2022

Autoimmune Bullous Diseases

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Spectrum of autoimmune bullous diseases among children in Kuwait

Cited by 9 publications

References 22 publications

Analysis of the Clinical Characteristics of Dipeptidyl Peptidase-4 Inhibitor–Induced Bullous Pemphigoid

Analysis of the Clinical Characteristics of Dipeptidyl Peptidase-4 Inhibitor–Induced Bullous Pemphigoid

Updates in the Diagnosis and Management of Linear IgA Disease: A Systematic Review

Autoimmune Bullous Diseases in Childhood

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