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Cutaneous Deposition of Polyclonal IgA1

Suzanne M. Olbricht, MD; Thomas J. Flotte, MD; A. Bernard Collins; Clifford M. Chapman, MS; Terence J. Harrist, MD

Arch Dermatol. 1986;122(4):418-421.

Abstract
• Dermatitis herpetiformis (DH) is a pruritic papulovesicular skin disorder of unknown cause, characterized by granular IgA deposits in the dermis along the dermoepidermal junction. It is associated with gluten-sensitive enteropathy and increased IgA production by gut lymphoid tissue. We report four cases of immunologically documented DH studied by immunofluorescence technique. Monoclonal antibodies against the IgA subclasses IgA1 and IgA2 were used. IgA1 without IgA2 was found in the cutaneous deposits in each case. The IgA1 had both and X light chains in approximately equal quantities. Because normal gut-associated lymphoid tissue produces 70% IgA1 and 30% IgA2, while circulating IgA is primarily IgA1, it could be concluded that the IgA in the skin of DH patients is not produced in the gut. However, the subclass restriction of the IgA produced by pathologic gut-associated lymphoid tissue is unknown. Alternatively, both IgA1 and IgA2 may be produced by the gut, but only IgA1 is involved in the production of cutaneous lesions.

(Arch Dermatol 1986;122:418-421)

Author Affiliations
From the Department of Dermatology, Beth Israel Hospital (Dr Olbricht), the Department of Pathology, Massachusetts General Hospital (Drs Flotte and Harrist and Mr Collins), and the Harvard Medical School and Pathology Services (Dr Harrist and Mr Chapman), Boston.

Footnotes
Accepted for publication Dec 20, 1985.

Presented in part at the 73rd annual meeting of the United States-Canadian Division of the International Academy of Pathology, San Francisco, March 12, 1984.

Reprint requests to Department of Dermatology, Beth Israel Hospital, 330 Brookline Ave, Boston, MA 02215 (Dr Olbricht).

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