Atopy in Chronic Urticaria: An Important yet Overlooked Issue

Abstract

Chronic urticaria (CU) is a common clinical disease that seriously affects the quality of life of patients, but its pathogenesis is still not fully understood. The autoimmunity of chronic spontaneous urticaria (CSU) has been highly concerned and intensively studied in the past. Atopy is also one of the important characteristics of CU, but it has not been fully recognized. Atopy is a predisposition to respond immunologically to allergens, leading to type 2 inflammation and overproduction of immunoglobulin E (IgE). Compared with the healthy population, patients with CU have a higher proportion of atopy, and atopic background is correlated with the clinical characteristics of CU. The total IgE level of CU patients is significantly higher than that of healthy people. Although it is not higher than that of classic allergic diseases, its level is also closely related to CU. Exogenous allergens, autoallergens and their specific IgE, which are closely related to atopy, have been gradually discovered in CU, and their roles in the pathogenesis of CU are also being studied. Atopic inflammation is equally present in CU, both locally and systemically. This review summarizes up-to-date knowledge regarding atopy and CU, and speculates that atopic CSU or atopic CIndU indeed exists, providing a fresh perspective for comprehensively understanding the clinical characteristics of CU and further studying its pathogenesis.

Features of chronic urticaria after COVID-19 mRNA vaccine, a real-life cohort study

“…This is corroborated by the rate of allergic rhinitis (28%) in CU patients which is comparable to the general population and confirmed by the Phadiatop analysis, which was positive in one-third of CU patients, a rate not higher than that observed in controls. Thus, the relationship between atopy and CU, while frequently discussed, is currently recognized as a co-occurring condition without a clear pathogenetic link (23,24). Even in cases of auto-allergic or type 1 CU, conditions associated with self-antigen IgEs like anti-TPO or anti-IL24 (25,26), atopic disease affects less than half of the patients (25).…”