Sensitivity and Specificity of <scp>ELISA</scp> Tests Detecting <scp>BP180</scp> and <scp>BP230</scp> Antibodies in the Diagnosis of Bullous Pemphigoid: A Systematic Review and Meta‐Analysis

Bullous pemphigoid (BP) is the most common autoimmune blistering disorder, mainly affecting elderly patients. Enzyme-linked immunosorbent assays (ELISA) targeting BP180 and BP230 autoantibodies are widely used in clinical practice, but their diagnostic accuracy has varied across studies. We conducted a systematic review and meta-analysis to evaluate the pooled diagnostic performance of these assays. Following PRISMA 2020 guidelines, we searched PubMed, Embase, and CENTRAL up to January 12, 2025, for studies assessing BP180 and/or BP230 ELISA in patients with clinically and/or immunopathologically confirmed BP. Seventeen studies including 1768 BP patients and 1382 controls met the inclusion criteria. Data extraction and risk of bias assessment were performed independently by two reviewers, and pooled estimates were calculated using a bivariate random-effects model. For BP180 ELISA, pooled sensitivity was 82.0% (95% confidence interval [CI]: 75.9%-86.8%) and specificity 94.1%. In contrast, BP230 ELISA demonstrated lower sensitivity at 58.6% (95% CI: 51.2%-65.7%) but maintained high specificity of 94.8% (95% CI 89.0-97.7). Risk of bias was generally low. Certainty of evidence, assessed with GRADE, was rated high for BP180 and low for BP230 due to imprecision and publication bias. Overall, BP180 ELISA shows high diagnostic accuracy and supports its use as a reliable, non-invasive diagnostic tool in routine practice. BP230 ELISA, although less sensitive, is best used as an adjunctive/confirmatory assay. These findings highlight the clinical value of serological assays in the diagnostic workup of bullous pemphigoid.