{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:47:01Z","timestamp":1785322021722,"version":"3.55.0"},"reference-count":14,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T00:00:00Z","timestamp":1639958400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Cutan Pathol"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Certain autoimmune bullous dermatoses are mediated by autoantibodies of the IgG4 subclass. We determined the diagnostic impact of adding IgG4 to our conventional direct immunofluorescence (DIF) panel.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>For all cases submitted to our referral laboratory for DIF over 1 month (n\u00a0=\u00a0630), we performed IgG4 testing and collected consecutive biopsy specimens showing definite or indeterminate linear or cell\u2010surface deposition of IgG, IgG4, and\/or C3. On retrospective blinded review, we classified the pattern and whether the findings were definite, indeterminate, or negative. When present, substantial background staining was recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy DIF specimens met the inclusion criteria. Of 22 (31.4%) specimens equivocal for linear or cell\u2010surface deposition, 9 (40.9%) had definitive IgG4 findings, either linear (3 of 14 equivocal linear cases; 21.4%) or cell\u2010surface (6 of 8 equivocal cell\u2010surface cases; 75.0%). Background deposition was substantial in 14 cases (20.0%) for IgG but in none for C3 or IgG4.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>IgG4 allowed the classification of over 40% of DIF cases that were otherwise equivocal by IgG and C3. IgG4 staining showed lower levels of non\u2010specific background staining than IgG or C3. IgG4 appears to contribute most value in cases with cell\u2010surface deposition or with equivocal linear IgG deposition and negative C3 results.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cup.14176","type":"journal-article","created":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T11:15:05Z","timestamp":1637838905000},"page":"358-362","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of adding an <scp>IgG4<\/scp> conjugate to routine direct immunofluorescence testing for subepithelial and intraepithelial autoimmune blistering disorders"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7389-3853","authenticated-orcid":false,"given":"Julia S.","family":"Lehman","sequence":"first","affiliation":[{"name":"Mayo Clinic Immunodermatology Laboratory, Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Laboratory Medicine and Pathology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma F.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Mayo Clinic Immunodermatology Laboratory, Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Laboratory Medicine and Pathology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Camilleri","sequence":"additional","affiliation":[{"name":"Mayo Clinic Immunodermatology Laboratory, Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Laboratory Medicine and Pathology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3918-3962","authenticated-orcid":false,"given":"Lawrence E.","family":"Gibson","sequence":"additional","affiliation":[{"name":"Mayo Clinic Immunodermatology Laboratory, Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Laboratory Medicine and Pathology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8001-2639","authenticated-orcid":false,"given":"Nneka I.","family":"Comfere","sequence":"additional","affiliation":[{"name":"Mayo Clinic Immunodermatology Laboratory, Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Laboratory Medicine and Pathology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amer N.","family":"Kalaaji","sequence":"additional","affiliation":[{"name":"Mayo Clinic Immunodermatology Laboratory, Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Laboratory Medicine and Pathology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2531-4869","authenticated-orcid":false,"given":"Margot S.","family":"Peters","sequence":"additional","affiliation":[{"name":"Mayo Clinic Immunodermatology Laboratory, Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Dermatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Laboratory Medicine and Pathology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek 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