Dermatitis herpetiformis, glomerulonephritis, and HLA-DRw3

Striking elevation of serum IgA, IgA-containing immune complexes, and IgA rheumatoid factor in clinically silent dermatitis herpetiformis

We describe a patient with dermatitis herpetiformis with immunoglobulin A (IgA)-containing circulating immune complexes and IgA rheumatoid factor who presented with acute renal insufficiency; a renal biopsy specimen showed IgA nephropathy. The renal function and proteinuria spontaneously returned to normal despite markedly elevated levels of IgA-containing circulating immune complexes, IgA rheumatoid factor, and IgA antibodies to some environmental antigens. IgA1 was the predominant subclass. IgA2-containing immune complexes and IgM rheumatoid factor were not detected. Cultures of peripheral blood mononuclear cells produced increased quantities of IgA and IgA rheumatoid factor spontaneously and after pokeweed mitogen stimulation. These data indicate that renal function can improve and remain normal despite the presence of increased levels of IgA-containing circulating immune complexes and IgA rheumatoid factor.

Dermatitis herpetiformis and glomerulonephritis. Case report and review of the literature

A patient who had a history of successfully treated dermatitis herpetiformis and in whom membranous glomerulopathy later developed is described. The predominant immunoglobulin present in the renal biopsy specimen was IgA. It is suggested that the dermatologic and renal diseases had a common immunologic origin. A review of the literature dealing with dermatitis herpetiformis and glomerulonephritis is included.

HLA and disease

This review describes the greater portion of a large number of new studies on HLA and disease association which has appeared in the literature since 1979. The majority of these are concerned with the association of certain diseases with class II major histocompatibility complex antigens. The possible biologic significance of these associations in terms of their probable etiology appears to be the prevailing theme. Current thinking regarding certain heritable diseases is described. It seems that although much has been done to resolve the genetics of insulin-dependent diabetes mellitus, other diseases such a multiple sclerosis still remain a mystery. Doubtlessly, much will be gained from DNA cloning and sequencing studies proposed for the future. A great deal of new information has been obtained relative to HLA itself. New loci have been postulated in the HLA-D/DR region through the use of powerful immunochemical procedures made possibly by the advent of modern technological advances. The impact of these developments on our understanding of the function of the MHC in man and its possible relationship to disease are discussed.

Some recent advances in HLA and skin diseases

During the past 15 years, much has been learned about the human major histocompatibility complex. These new findings have been applied to the whole field of medicine, including transplantation immunology, blood transfusions, association with disease, human genetics, and the mechanism of human immune responses. In clinical medicine, the association between the major histocompatibility complex and various diseases has attracted the greatest interest. In this paper, we summarize the basic information on the human histocompatibility complex and its association with dermatologic disorders. Data from the world literature are reviewed and tabulated. Our own investigations on psoriasis, atopic dermatitis, and epidermolysis bullosa are discussed in detail.