{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T04:31:19Z","timestamp":1775795479218,"version":"3.50.1"},"reference-count":96,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Oral Pathology Medicine"],"published-print":{"date-parts":[[2026,4]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objectives<\/jats:title>\n \n Direct immunofluorescence (\n DIF<\/jats:styled-content>\n ) is the gold standard for diagnosing subepidermal blistering diseases (\n SBDs<\/jats:styled-content>\n ). However,\n DIF<\/jats:styled-content>\n requires specialized expertise; therefore, alternative immunological methods such as enzyme\u2010linked immunosorbent assays (\n ELISA<\/jats:styled-content>\n ) are worth exploring. The aim of this review was to evaluate the diagnostic agreement between\n DIF<\/jats:styled-content>\n and\n ELISA<\/jats:styled-content>\n for the diagnosis of\n SBD<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Materials and Methods<\/jats:title>\n \n A systematic literature review of international journals and electronic databases (\n MEDLINE<\/jats:styled-content>\n via\n OVID<\/jats:styled-content>\n , Scopus, and Web of Science) was conducted between their inception and December 2023. The risk of bias and overall quality of evidence were assessed using the Newcastle\u2010Ottawa Scale and the\n GRADE<\/jats:styled-content>\n system.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 1691 articles identified, 38 were included in the qualitative synthesis and 37 in the quantitative analysis. Three meta\u2010analyses were developed and revealed the superiority of\n DIF<\/jats:styled-content>\n over\n ELISA<\/jats:styled-content>\n , with the following risk differences:\n BP180<\/jats:styled-content>\n , 0.26 (95%\n CI<\/jats:styled-content>\n : 0.19\u20130.33,\n p<\/jats:italic>\n \u2009<\u20090.00001,\n \n I<\/jats:italic>\n 2<\/jats:sup>\n <\/jats:styled-content>\n : 96%);\n BP230<\/jats:styled-content>\n , 0.59 (95%\n CI<\/jats:styled-content>\n : 0.47\u20130.71,\n p<\/jats:italic>\n \u2009<\u20090.00001,\n \n I<\/jats:italic>\n 2<\/jats:sup>\n <\/jats:styled-content>\n : 98%); and Lam332, 0.82 (95%\n CI<\/jats:styled-content>\n : 0.70\u20130.94,\n p<\/jats:italic>\n \u2009<\u20090.00001,\n \n I<\/jats:italic>\n 2<\/jats:sup>\n <\/jats:styled-content>\n : 89%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n DIF<\/jats:styled-content>\n remains the gold standard for the diagnosis of autoimmune\n SBDs<\/jats:styled-content>\n .\n ELISA<\/jats:styled-content>\n can serve as a complementary diagnostic tool, especially as a follow\u2010up instrument for patients with\n SBD<\/jats:styled-content>\n , owing to its low invasiveness.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jop.70088","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T02:31:37Z","timestamp":1765593097000},"page":"391-418","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Agreement in Subepidermal Blistering Diseases: Is\n ELISA<\/scp>\n Test Reliable as Direct Immunofluorescence? A Systematic Review, Meta\u2010Analysis, and Trial Sequential Analysis"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7358-8763","authenticated-orcid":false,"given":"Romeo","family":"Patini","sequence":"first","affiliation":[{"name":"Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli\u2014IRCCS, School of Dentistry Universit\u00e0 Cattolica del Sacro Cuore Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8637-2029","authenticated-orcid":false,"given":"Gioele","family":"Gioco","sequence":"additional","affiliation":[{"name":"Head and Neck Department, Fondazione Policlinico Universitario A. 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Gemelli\u2014IRCCS, School of Dentistry Universit\u00e0 Cattolica del Sacro Cuore Rome Italy"},{"name":"Oral Surgery Postgraduate School, Department of Medical Biotechnologies University of Siena Siena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1862-4821","authenticated-orcid":false,"given":"Davide","family":"Gentile","sequence":"additional","affiliation":[{"name":"Department of Chemical Science and Technologies, PhD in Materials for Sustainable Development \u2013 Dentistry University of Rome Tor Vergata Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9928-4100","authenticated-orcid":false,"given":"Cosimo","family":"Rupe","sequence":"additional","affiliation":[{"name":"Head and Neck Department, Fondazione Policlinico Universitario A. 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