Serum reactivity in dermatitis herpetiformis: an international multicentre study

Katharina Boch, Florian Heck, Christoph M. Hammers, Emiliano Antiga, Marzia Caproni, David Juhl, Stephanie Goletz, Orsolya N. Horváth, Laura Huilaja, Stanislav Khil'chenko, Christian Sina, Kaisa Tasanen, Snejina Vassileva, Wolfgang Schlumberger, Detlef Zillikens, Martin Shahid, Kossara Drenovska, John J. Zone, Kamilla Koszorú, Kai FechnerCornelia Dähnrich, Inke R. König, Enno Schmidt*

*Corresponding author for this work


Background: Dermatitis herpetiformis (DH) is a rare gluten-induced skin disorder characterized predominantly by IgA autoantibodies against endomysium, tissue transglutaminase (TG2/tTG), epidermal transglutaminase (TG3/eTG) and deamidated gliadin. To date, circulating autoantibody reactivity has not been systematically described. Objectives: Characterization of serum reactivities in DH. Methods: This multicentre international study analysed sera from 242 patients with DH taken at the time of initial diagnosis. DH-specific IgA and IgG serum autoantibodies were analysed by indirect immunofluorescence (IF) on monkey oesophagus, and by enzyme-linked immunosorbent assay (ELISA) based on recombinant TG2/tTG, TG3/eTG and deamidated gliadin (GAF3X). Results: IgA indirect IF microscopy on monkey oesophagus revealed the highest reactivity (84.3%; specificity 100%) followed by IgA TG2/tTG ELISA (78.5%, specificity 99.0%), IgA TG3/eTG ELISA (72.7%, specificity 95.0%) and IgA GAF3X ELISA (69.0%, specificity 98.5%). Conclusions: Serum IgA and IgG autoantibodies against endomysium, TG2/tTG, TG3/eTG and deamidated gliadin are highly prevalent in DH. Indirect IF microscopy on monkey oesophagus (IgA) provides the highest diagnostic accuracy that can be further enhanced by 4.5% when combined with IgA TG2/tTG ELISA.

Original languageEnglish
JournalClinical and Experimental Dermatology
Issue number1
Pages (from-to)53-57
Number of pages5
Publication statusPublished - 19.12.2023

Research Areas and Centers

  • Academic Focus: Center for Infection and Inflammation Research (ZIEL)
  • Centers: Center for Research on Inflammation of the Skin (CRIS)

DFG Research Classification Scheme

  • 205-19 Dermatology
  • 204-05 Immunology

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