Diagnosis of pemphigus by ELISA: a critical evaluation of two ELISAs for the detection of antibodies to the major pemphigus antigens, desmoglein 1 and 3

Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are characterized by a utoantibodies to the desmosomal glycoproteins desmoglein 3 (Dsg 3) and Dsg 1 (Dsg 1), respectively. In this study, two enzyme-linked immunosorbent ass ays (ELISA) which detect IgG autoantibodies to Dsg 1 and Dsg 3 have been ev aluated. A total of 317 normal and disease controls, 82 patients with PV an d 25 with PF were studied. The Dsg 3 ELISA was positive in all 34 patients with untreated PV and the Dsg 1 ELISA was positive in all 10 with untreated PF. When patients undergoing treatment were included, the sensitivities fe ll to 95% and 92%, respectively, but still compared favourably to the sensi tivity of indirect immunofluorescence which was 79% in PV and 84% in PF. Al l PF sera were negative in the Dsg 3 ELISA and the specificity of both assa ys was 98% or greater. Large numbers of samples could be analysed simultane ously over a relatively short time period. The Dsg 1 and Dsg 3 ELISAs also provided objective, quantitative, reproducible data which allowed different iation of PV from PF and in view of these advantages, they are likely to be come a routine technique in diagnostic laboratories.