Histone Antibody

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Detects histone autoantibodies.

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Histone Antibody Test Information Guide

Why is it done?
- Detects and measures anti-histone antibodies in the blood, which are autoimmune markers indicating the body's immune system is attacking histone proteins found in cell nuclei
- Diagnose and monitor drug-induced lupus erythematosus (DILE), particularly in patients taking medications such as hydralazine, procainamide, quinidine, isoniazid, or minocycline
- Support diagnosis of systemic lupus erythematosus (SLE) and other autoimmune connective tissue diseases, particularly when other serological markers are negative
- Evaluate patients presenting with symptoms of lupus-like syndrome including joint pain, fever, rash, and chest pain
- Differentiate between idiopathic SLE and medication-induced autoimmune disease
- Typically performed when patients have clinical symptoms suggestive of lupus or when initiating medications known to cause drug-induced lupus
Normal Range
- Negative or Undetectable: Less than 1.0 U/mL or reported as 'Negative' - indicates absence of anti-histone antibodies
- Units of Measurement: U/mL (Units per milliliter) or EU/mL (ELISA Units per milliliter), depending on laboratory method
- Borderline Range: 1.0-1.5 U/mL - may require clinical correlation and possible repeat testing
- Positive: Greater than 1.5 U/mL - indicates presence of detectable anti-histone antibodies
- Normal Result Interpretation: Absence of anti-histone antibodies suggests the immune system is not actively producing antibodies against histone proteins; however, negative results do not rule out autoimmune disease, as other antibodies may be present
- Abnormal Result Interpretation: Positive results indicate the presence of autoimmune activity against histone proteins, which is highly suggestive of drug-induced lupus or associated with systemic autoimmune diseases
- Reference ranges may vary slightly between laboratories and testing methodologies; always compare results to the specific laboratory's reference values
Interpretation
- Negative Result (Less than 1.0 U/mL): Suggests no detectable anti-histone antibodies; makes drug-induced lupus less likely if patient is on suspect medications; does not rule out SLE or other autoimmune conditions, as other serological markers may be present
- Borderline Result (1.0-1.5 U/mL): Requires clinical correlation with patient symptoms and medication history; may represent early autoimmune response or low-level antibody production; repeat testing may be recommended in 2-4 weeks
- Positive Result (Greater than 1.5 U/mL): Strongly indicates drug-induced lupus if patient is taking causative medications; supports diagnosis of SLE or other autoimmune connective tissue disease; correlates highly with clinical symptoms of lupus-like syndrome
- Very High Positive Result (Greater than 3.0 U/mL): Indicates significant autoimmune activity; particularly suggestive of active drug-induced lupus; may warrant medication discontinuation or adjustment
- Factors Affecting Results:
- Medication use: Prolonged exposure to hydralazine, procainamide, quinidine, isoniazid, minocycline, and other medications increases likelihood of positive results
- Duration of medication exposure: Anti-histone antibodies typically develop after months of continuous medication use
- Genetic predisposition: Certain HLA types increase susceptibility to drug-induced lupus
- Presence of other autoimmune conditions: May increase likelihood of positive results
- Sample handling and storage: Proper collection and processing are essential for accurate results
- Clinical Significance:
- Anti-histone antibodies are present in approximately 95% of drug-induced lupus cases, making this test highly sensitive for DILE diagnosis
- Found in 50-70% of SLE patients but is not specific for SLE alone; must be interpreted with other clinical findings and serological markers
- Results typically normalize within 6 months after discontinuation of the causative medication in drug-induced lupus cases
Associated Organs
- Primary Organ Systems Involved:
- Immune system: Central to the autoimmune response that produces anti-histone antibodies
- Connective tissues: Target tissues affected in lupus-like diseases
- Joints: Frequently affected with arthritis and joint pain
- Skin: Common manifestation including malar rash and photosensitivity
- Heart and lungs: Can develop inflammation, serositis, and pleurisy
- Kidneys: Potential development of lupus nephritis with glomerulonephritis
- Diseases Associated with Abnormal Results:
- Drug-induced lupus erythematosus (DILE): Most specific association; occurs in patients on medications such as hydralazine (15-20% incidence), procainamide (20%), quinidine, isoniazid, minocycline, and others
- Systemic lupus erythematosus (SLE): Present in 50-70% of patients; one of multiple markers used for diagnosis
- Rheumatoid arthritis: May be present in some patients with autoimmune polyarthritis
- Sjögren's syndrome: Can present with anti-histone antibodies in subset of patients
- Antiphospholipid syndrome: May coexist with anti-histone antibody positivity
- Scleroderma: Can present with multiple autoimmune markers including anti-histone antibodies
- Potential Complications Associated with Abnormal Results:
- Lupus nephritis and progressive kidney disease with potential for renal failure
- Cardiovascular complications including myocarditis, pericarditis, and increased atherosclerosis risk
- Pulmonary involvement with pleurisy, pulmonary hemorrhage, and chronic interstitial lung disease
- Hematologic complications including hemolytic anemia and thrombocytopenia
- Thrombosis and increased risk of venous or arterial events in patients with concurrent antiphospholipid syndrome
- Neurological manifestations including cognitive impairment and seizures
Follow-up Tests
- Recommended Follow-up Tests Based on Positive Results:
- Antinuclear antibody (ANA): Comprehensive marker for autoimmune disease; typically positive in lupus and drug-induced lupus
- Anti-double stranded DNA (anti-dsDNA) antibody: Specific for SLE; helps differentiate from drug-induced lupus
- Anti-Smith (anti-Sm) antibody: Highly specific for SLE; rarely positive in DILE
- Complement levels (C3 and C4): Assess disease activity and inflammation; low levels indicate more severe disease
- Complete blood count (CBC): Evaluate for cytopenias including anemia, leukopenia, and thrombocytopenia
- Comprehensive metabolic panel: Assess kidney and liver function, electrolytes, and glucose
- Urinalysis and urine protein: Screen for lupus nephritis and kidney involvement
- 24-hour urine protein: Quantify proteinuria if significant protein detected in routine urinalysis
- Erythrocyte sedimentation rate (ESR): Non-specific marker of inflammation; elevated in active disease
- C-reactive protein (CRP): Assess acute phase inflammation
- Additional Specialized Tests:
- Anti-ribosomal P protein antibodies: Support diagnosis of SLE
- Anti-Ro/SSA and Anti-La/SSB antibodies: Assess for Sjögren's syndrome and other autoimmune conditions
- Anticardiolipin and anti-beta 2 glycoprotein I antibodies: Screen for antiphospholipid syndrome
- Tissue typing (HLA-B27, HLA-DR3): Assess genetic predisposition to autoimmune disease
- Imaging and Diagnostic Procedures:
- Chest X-ray: Evaluate for pleural effusions, pulmonary infiltrates, or cardiac involvement
- Electrocardiogram (ECG): Screen for pericarditis or myocarditis
- Echocardiography: Assess cardiac function and pericardial involvement if indicated
- Kidney biopsy: Perform if significant proteinuria or hematuria detected to assess for lupus nephritis
- Monitoring Frequency for Ongoing Conditions:
- Drug-induced lupus: Retest every 3-6 months after medication discontinuation to confirm normalization of antibodies
- SLE patients: Monitor serologies (ANA, anti-dsDNA, complement levels) every 3 months during active disease or with clinical changes
- Kidney disease monitoring: Quarterly assessment of creatinine, urinalysis, and urine protein in patients with lupus nephritis
- Stable disease: Annual or biannual monitoring of serologies and clinical parameters
Fasting Required?
- No fasting is required for the Histone Antibody test
- The test measures antibodies in blood and is not affected by food or fluid intake
- Patients may eat and drink normally before the blood draw
- No Medications to Avoid: Continue all current medications unless specifically instructed otherwise by the healthcare provider; patients taking medications that may cause drug-induced lupus should continue these unless advised to discontinue by their physician
- Patient Preparation Requirements:
- Bring valid photo identification and insurance card to the blood draw appointment
- Inform the phlebotomist of any bleeding disorders, medications affecting blood clotting, or history of fainting during blood draws
- List all current medications, supplements, and herbal products being taken
- Avoid strenuous exercise 24 hours before the blood draw if possible, as physical exertion may temporarily affect antibody levels
- Stay hydrated by drinking adequate water before the appointment, which may make blood collection easier
- Wear loose-fitting clothing with accessible upper arms for easier blood draw access
- The test typically takes only a few minutes, requiring a single blood draw, usually 5-10 mL of blood
- Results are typically available within 3-5 business days, depending on the laboratory

How our test process works!