To the Editor Ms Ajamian and colleagues quoted our work that found an association between autism spectrum disorder (ASD) and Lyme disease in their research letter on serological markers of Lyme disease in children with autism. Their study used the Centers for Disease Control and Prevention (CDC) testing criteria with enzyme-linked immunosorbent assays (ELISAs) followed by Western blotting. These assays, provided by Euroimmun, have only a 45% to 49% sensitivity. In addition, the patients were aged 2 to 18 years and developed autism as much as 18 years before the blood samples were drawn. A low sensitivity ELISA performed years later does not prove these patients were not exposed to an immune process triggered by Borrelia burgdorferi at the time the pathological process began. Only 5 of the 70 children with autism were tested with the more sensitive Western blot. In contrast, we cited studies that collectively included 130 children with ASDs and 62 controls tested by either Western blot without the full complement of specific bands or forensic polymerase chain reaction and Southern blot confirmation.3'5 Reactivity of B burgdorferi-specific bands on Western blot without the full number of bands meeting the CDC surveillance criteria is a more reliable indicator of prior exposure to B burgdorferi.
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