There is considerable debate whether chronic urticaria is an autoimmune disease or whether its features suggestive of autoimmunity are epiphenomena. A plethora of circumstantial evidence suggests that chronic urticaria is an autoimmune disease, but criteria to establish autoimmunity require direct proof and indirect evidence, and these are lacking in chronic urticaria. Current approaches to assessing for autoimmunity in vivo via the autologous serum skin test, and in vitro via either basophil histamine release or the basophil activation test are widely utilized, but the results of these tests have limited impact on prediction of the clinical course and efficacy of treatments. Recent guidelines for diagnosing autoimmune urticaria have been proposed, but further investigation is needed.

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Treatment of chronic urticaria refractory to antihistamines presents a challenge to both people affected with the disease as well as the physicians who treat them. Omalizumab, a monoclonal antibody against IgE, has emerged as one potential solution to this challenge. In several clinical trials published between 2011 and 2013, omalizumab significantly reduced or eliminated symptoms of chronic urticaria. The optimal dose for chronic urticaria is 300 mg administered every 4 weeks, a dose that differs from those used in asthma, which are based on the patient's weight and IgE level. Omalizumab does not appear to cause lasting symptom remission, and the ideal duration of treatment for chronic urticaria has not been defined.

In order to evaluate comorbidity of type I allergic disorders in patients with Rheumatoid Arthritis (RA), we studied their morbidity of allergic disease and prevalence of sensitivity to some of the important inhaled allergens in Japan. METHODS: In 99 outpatients with RA, males 20/females 79, average age 65613 Y-O, we checked their allergic history and symptoms by questionnaire and examined their serum IgE levels, which were HD-Mite (HDM), Japanese Cedar (JC), Orchard Grass (OG). All of them consented to our study. Moreover, from June to October in 2013 our hospital used 179 middle aged employees without RA as a control group, males 51/females 128 and average 4868 Y-O, studying the same data as the RA patients. RESULTS: Allergic history and/or symptoms of RA patients were Allergic Rhinitis and/or Pollinosis (AR/P) 30.3%, Bronchial Asthma 8.1%, Atopic dermatitis 2% and Urticaria 11.1%. Those of the control group were, respectively, 31.3%, 3.9%, 3.4% and 4.4%. In RA patients the percentage of AR/P was almost the same as the control group. On the other hand positive sensitivity (over class 2) to the inhaled allergens in RA patients was HDM 15.2%, JC 27.3% and OG 11.1%. In the Control group it was, respectively, 40.2%, 50.5% and 13.4%. The sensitivity rate of HDM and JC was significantly lower (p<0.001) in RA patients than in the control group. CONCLUSIONS: RA patients had a lower sensitivity to HDM and JC antigens than the control group but had the same positive allergic history/ symptoms as the control group.