Indian dermatology online journal
October 8, 2026 · via Europe PMC
Correlation of Serum and Tissue Eosinophils and Immunoglobulin E with Disease Severity in Bullous Pemphigoid: A Prospective Observational Study.
Krishnamoorthy K, Rai R, Shanmugasundaram S.
AI summary — for doctors, generated from the abstract only
In bullous pemphigoid, eosinophil-rich inflammation on biopsy was strongly associated with higher disease activity, but serum eosinophils and IgE were not.
What was studied
Prospective observational study of 35 patients with confirmed BP at a South Indian tertiary center (Oct 2023 to Dec 2024), relating BPDAI severity to serum eosinophils, serum IgE, histology and IgE deposition on direct immunofluorescence.
Key findings
- Higher disease activity (BPDAI >20/372) was seen in 77% (27/35)
- No significant association was found for serum eosinophils, serum IgE or DIF IgE deposition
- Eosinophil-predominant infiltrates on biopsy were associated with higher activity (OR 9.638; 95% CI 1.613-56.952; P = 0.029)
Clinical relevance
Tissue eosinophilia may help gauge severity and supports the role of eosinophils in pathogenesis.
Who should care
Limitations
Small sample, cross-sectional, biopsy site variability, and the study was not powered for the tissue eosinophil finding; the confidence interval is very wide.
Biopsy eosinophils, not blood markers, tracked BP severity in this small study.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Bullous pemphigoid (BP) is a subepidermal autoimmune blistering disorder in which eosinophils and immunoglobulin E (IgE) are implicated in disease pathogenesis and are potential markers of disease activity.
Aim and objective
To evaluate the association of serum and tissue eosinophils and IgE levels with disease severity in BP.
Patients and methods
A prospective observational study was conducted from October 2023 to December 2024 at a tertiary care center in South India. Thirty-five patients with clinically and histopathologically confirmed BP were included, disease severity was assessed using the bullous pemphigoid disease activity index (BPDAI). Serum eosinophil counts, serum IgE levels, histopathology, and direct immunofluorescence (DIF) findings for IgE deposition at the basement membrane zone (BMZ) were analyzed.
Results
Higher disease activity (BPDAI >20/372) was observed in 77% of patients (27/35). Fisher's exact test showed no significant association between higher BPDAI scores and elevated serum eosinophil counts (>500 cells/μL), elevated serum IgE levels (>500 IU/mL) or DIF-detected IgE deposition at BMZ. However, biopsy evidence of eosinophil-predominant inflammatory infiltrates was significantly associated with higher disease activity (odds ratio [OR] =9.638; 95% confidence interval [CI]: 1.613-56.952; P = 0.029).
Limitations
Small sample size, cross-sectional analysis, biopsy site variability and immunofluorescence methodology may have limited detection of IgE-related associations. Sample size calculation was based on the expected prevalence of IgE reactivity, but the significant association identified in our study involved tissue eosinophilia, for which the study was not specifically powered.
Conclusion
Eosinophilic infiltration is strongly associated with BP severity, reinforcing its pathogenic role. Although serum IgE was frequently elevated, its correlation with severity was more evident when also detected in tissue.
DOI
10.4103/idoj.idoj_963_25
PMID
42849025
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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