Test Catalog

Test Id : CIFS

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Cutaneous Immunofluorescence Antibodies, IgG and IgG4, Serum

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Confirming the presence of IgG and/or IgG4 antibodies to diagnose pemphigoid, pemphigus, epidermolysis bullosa acquisita, or bullous lupus erythematosus

Reflex Tests
Lists tests that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial tests.

Test Id Reporting Name Available Separately Always Performed
CIFST CIFS Titer, IgG, S No No

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If IgG anti-cell surface or anti-basement membrane zone antibodies are present, then the IgG antibody titer will be reflexed and performed at an additional charge.

Method Name
A short description of the method used to perform the test

Indirect Immunofluorescence Assay (IFA)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Cutaneous Immfluor. Ab, IgG/IgG4, S

Aliases
Lists additional common names for a test, as an aid in searching

Basement Membrane Antibodies

Bullous Pemphigoid

Cicatricial Pemphigoid

CII, Serum

Circulating IgG Basement Membrane Zone Antibody

Circulating Intercellular Ab Study

Epidermal Cell Surface Antibody

Epidermal Fluorescence Antibody

Epidermolysis Bullosa Acquisita

Epithelial Antibody

Herpes gestationis

IMF - Epidermal Fluorescent Ab

Indirect Immunofluorescence

Intercellular Substance Antibody

Pemphigoid

Pemphigus

Skin Basement Membrane Antibodies

Split-Skin Assay

Lupus Erythematosus (LE)

Bullous Lupus Erythematosus

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If IgG anti-cell surface or anti-basement membrane zone antibodies are present, then the IgG antibody titer will be reflexed and performed at an additional charge.

Specimen Type
Describes the specimen type validated for testing

Serum

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Collection Container/Tube:

Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 2 mL

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.

0.5 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Serum Ambient 14 days
Refrigerated (preferred) 14 days
Frozen 30 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Confirming the presence of IgG and/or IgG4 antibodies to diagnose pemphigoid, pemphigus, epidermolysis bullosa acquisita, or bullous lupus erythematosus

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If IgG anti-cell surface or anti-basement membrane zone antibodies are present, then the IgG antibody titer will be reflexed and performed at an additional charge.

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Immunoglobulin G (IgG) and/or IgG4 anti-basement membrane zone (BMZ) antibodies are produced by patients with pemphigoid, pemphigus, and other rare autoimmune blistering disorders such as epidermolysis bullosa acquisita and bullous lupus erythematosus. In most patients with bullous pemphigoid, serum contains IgG anti-BMZ antibodies, while in cicatricial pemphigoid circulating IgG anti-BMZ antibodies are found in a minority of cases.

 

Circulating IgG4 is also variably present. Sensitivity of detection of anti-BMZ antibodies is increased when serum is tested using both sodium chloride-split primate skin and primate esophagus as substrates and using both IgG and IgG4 reactants.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Negative in normal individuals

Interpretation
Provides information to assist in interpretation of the test results

Indirect immunofluorescence (IF) testing may aid in the diagnosis of these conditions when correlated with histopathologic, direct immunofluorescence, and clinical information.

 

Anti-basement membrane zone (BMZ) antibodies correlate with a diagnosis of bullous pemphigoid, cicatricial pemphigoid, epidermolysis bullosa acquisita (EBA), or bullous eruption of lupus erythematosus (LE).

 

Anti-cell surface antibodies correlate with a diagnosis of pemphigus.

 

If serum contains anti-BMZ antibodies, the pattern of fluorescence on sodium chloride (NaCl)-split skin substrate helps distinguish pemphigoid from EBA and bullous LE. Staining of the roof (epidermal side) or both epidermal and dermal sides of NaCl-split skin correlates with the diagnosis of pemphigoid, while fluorescence localized only to the dermal side of the split-skin substrate correlates with either EBA or bullous LE.

 

The report includes presence and titer of circulating antibodies.

 

If the serum contains BMZ antibodies on the split-skin substrate, patterns will be reported as one of the following:

1. Epidermal pattern, suggestive of pemphigoid

2. Dermal pattern, suggestive of epidermolysis bullosa acquisita, bullous lupus erythematosus, or rare pemphigoid variants

3. Mixed pattern, suggestive of rare pemphigoid variants

 

If serum contains BMZ antibodies on the primate esophagus substrate, patterns will be reported as one of the following:

-BMZ (linear) pattern, suggestive of a subepidermal autoimmune mucocutaneous blistering disorder

-Intercellular substance (cell-surface) pattern, suggestive of pemphigus

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Results should be interpreted in conjunction with clinical information, histopathologic pattern, and results of direct immunofluorescence (DIF) study. In particular, the finding of low titer (< or =1:80) antibodies should not be used alone (ie, without histopathologic or DIF support) to diagnose these conditions.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Beutner EH, Chorzelski TP, Kumar V, eds. Immunopathology of the Skin. 3rd ed. Wiley Medical Publication; 1987

2. Gammon WR, Briggaman RA, Inman AO 3rd, Queen LL, Wheeler CE. Differentiating anti-lamina lucida and anti-sublamina densa anti-BMZ antibodies by indirect immunofluorescence on 1.0 M sodium chloride-separated skin. J Invest Dermatol. 1984;82(2):139-144

3. Tirumalae R, Kalegowda IY. Role of BIOCHIP indirect immunofluorescence test in cutaneous vesiculobullous diseases. Am J Dermatopathol. 2020;42(5):322-328

4. Lehman JS, Aghazadeh Mohandesi N, Agrawal S, et al. Indirect immunofluorescence testing for immunoglobulin G4 and IgG increases test sensitivity over that of IIF testing for IgG alone for pemphigoid and pemphigus diseases: A retrospective study of 278 cases. J Am Acad Dermatol. 2024:S0190-9622(24)03372-3

Method Description
Describes how the test is performed and provides a method-specific reference

Frozen sections of primate esophagus and sodium chloride-split primate skin are overlaid with dilutions of patient's serum, incubated, covered with fluorescein-conjugated IgG and IgG4 anti-serum, and interpreted using a fluorescence microscope.(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 7 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

30 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

88346

88350

88350 (if appropriate)

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
CIFS Cutaneous Immfluor. Ab, IgG/IgG4, S In Process
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
21539 Cell Surface Ab IgG 93233-5
21540 Basement Membrane IgG 29994-1
21542 Primate Split Skin IgG 104832-1
21638 Other 48767-8
622319 Cell Surface Ab IgG4 In Process
622320 Basement Membrane IgG4 In Process
622322 Primate Split Skin IgG4 In Process

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports

Test Update Resources

Change Type Effective Date
File Definition - Algorithm 2025-06-10