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Updated: May 24, 2026

Electrochemiluminescence Assays for Human Islet Autoantibodies
Published on: March 23, 2018
Linagliptin is a risk factor for bullous pemphigoid associated with BP180-NC16A/BP230 seronegativity and milder
Anna Pira1, Adele Salemme1, Feliciana Mariotti1
1Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy.
Background:
Despite the established association between gliptins and bullous pemphigoid (BP), knowledge of BP risk and its clinical and immunological phenotypes among individual gliptins remains fragmentary.
Objective:
To estimate BP risk among different gliptins, compare the demographic, clinical, and immunological profiles of idiopathic and patients with bullous pemphigoid and gliptin-treated type 2 diabetes (BPT2D-G), and evaluate the diagnostic performance of a BP180-ectodomain enzyme-linked immunosorbent assay.
Methods:
Patients with BP and/or type 2 diabetes who visited 2 Italian hospitals during 2019 to 2023 were prospectively enrolled and clinically/immunologically characterized in a case-control study using in-house enzyme-linked immunosorbent assays detecting reactivity to BP180 extracellular epitopes.
Results:
Overall, gliptin exposure demonstrated a strong association with BP, whereas sitagliptin did not exhibit a comparable effect. BPT2D-G showed a distinctive humoral profile, with high reactivity to other epitopes beyond BP180-noncollagenous 16A domain. A subset of patients, mainly exposed to linagliptin and BP180-noncollagenous 16A domain/BP230 negative, presented milder, often noninflammatory disease: a BP180-ectodomain assay improved diagnostic performances in these patients.
Limitations:
Potential residual confounding; limited generalizability; limited data on gliptin exposure duration. The observational design precludes causal inference.
Conclusion:
Different BP risks among gliptins may inform therapeutic choices, favoring sitagliptin in elderly patients. Personalized management of patients with BP180-noncollagenous 16A domain/BP230-negative BPT2D-G may reduce unnecessary use of high-potency topical and systemic corticosteroids. BP180-ectodomain-based diagnostic assays may facilitate BPT2D-G diagnosis.
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