Antihistone Antibodies

TEST: 012518
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CPT: 86235
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Synonyms

  • DIL
  • Drug-induced Lupus Antibodies
  • H2a/H2b and H3 and H4 Antibodies
  • Histone Antibodies

Test Includes

Semiquantitative result of IgG class antibodies

Expected Turnaround Time

2 - 5 days

Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary.

Related Documents

Specimen Requirements

Specimen

Serum

Volume

1 mL

Minimum Volume

0.5 mL (Note: This volume does not allow for repeat testing.)

Container

Red-top tube or gel-barrier tube

Storage Instructions

Maintain specimen at room temperature.

Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Causes for Rejection

Hemolysis; icterus; lipemia; bacterial contamination

Test Details

Use

Histones are lysine-rich and arginine-rich basic proteins of eukaryotic cells which are predominantly found as complexes with DNA. Antibodies to histones are detected in approximately 30% to 60% of patients with systemic lupus erythematosus (SLE), but their presence in about 95% of patients with drug-induced lupus is more important diagnostically. Drug-induced lupus (primarily caused by procainamide and hydralazine) is clinically similar to SLE, except that the former patients do not have kidney or central nervous system involvement and they do not demonstrate the multiple types of antinuclear antibodies (ANAs) often found in SLE patients. In addition, drug-induced antihistone antibodies react strongly with H2a/H2b fragments (in procainamide-induced SLE) as well as H3 and H4 (in hydralazine-induced SLE). In patients with drug-induced lupus, antihistone antibodies are usually the only ANAs, although antibodies to denaturated DNA have been detected in a small percentage of patients. Antihistone antibodies also occur in approximately 20% of patients with rheumatoid arthritis.

Limitations

The expected value in the normal population is negative; however, apparently healthy individuals may contain ANA in their sera. This percentage increases with aging, particularly in the seventh decade of life. Certain therapeutic drug regimens and viral syndromes may also cause ANAs.

Methodology

Enzyme-linked immunosorbent assay (ELISA)

Reference Interval

• Negative: <1.0 units

• Weak positive: 1.0−1.5 units

• Moderate positive: 1.6−2.5 units

• Strong positive: >2.5 units

References

Biundo JJ, Cummings NA. Biochemical, hematologic and immunologic tests. In: Katz AW, ed. Rheumatic Disease, Diagnosis and Management. Philadelphia, Pa: JB Lippincott;1977:265.
Centers for Disease Control and Prevention. National Institutes of Health.Biosafety in Microbiological and Biomedical Laboratories. 5th ed. Atlanta, Ga:CDC; 2007.
Epstein A, Barland P. The diagnostic value of antihistone antibodies in drug-induced lupus erythematosus. Arthritis Rheum. 1985 Feb; 28(2):158-162. 3882094
Fritzler MJ, Tan EM. Antibodies to histones in drug-induced and idiopathic lupus erythematosus. J Clin Invest. 1978 Sep; 62(3):560-567. 357449
Gockel S, Binder WL. Immunoglobulin class specificity of antihistone. Arthritis Rheum. 1985; 25:558.
Klajman A, Kafri B, Shohat T, Drucker I, Moalem T, Jaretzky A. The prevalence of antibodies to histones induced by procainamide in old people, in cancer patients, and in rheumatoid-like disease. Clin Immunol Immunopathol. 1983 Apr; 27(1):1-8. 6603311
Krippner H, Springer B, Merle S, Pirlet K. Antibodies to histones of the IgG and IgM class in systemic lupus erythematosus. Clin Exp Immunol. 1984 Oct; 58(1):49-56. 6332696
Portanova JP, Rubin RL, Joslin FG, Agnello VD, Tan EM. Reactivity of anti-histone antibodies induced by procainamide and hydralazine. Clin Immunol Immunopathol. 1982 Oct; 25(1):67-79. 6983942
Rubin RL, Joslin FG, Tan EM. Specificity of antihistone antibodies in systemic lupus erythematosus. Arthritis Rheum. 1982 Jul; 25(7):779-782. 6980652

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
012518 Antihistone Antibodies 29996-6 012522 Anti-histone Abs Units 29996-6

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