IgE antithyroid microsomal antibodies in a patient with chronic urticaria

Bar-Sela, S; Reshef, Tamar; Mekori, Yoseph A.

doi:10.1016/s0091-6749(99)70204-6

Cited by 40 publications

(20 citation statements)

References 5 publications

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“…These IgE autoantibodies are held to be relevant for the pathogenesis of CSU in a subpopulation of patients . IgE‐anti‐TPO autoantibodies, when bound on the surface of mast cells and basophils, could cause “autoallergic” activation and degranulation of cells, after exposure to the specific circulating antigen, which is released as a result of autoimmune thyroid damage …”

Section: Resultsmentioning

confidence: 99%

Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: A systematic review

Kolkhir

Metz

Altrichter

et al. 2017

Allergy

149

118

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Patients with chronic spontaneous urticaria (CSU) are widely held to often have other autoimmune disorders, including autoimmune thyroid disease. Here, we systematically evaluated the literature on the prevalence of thyroid autoimmunity in CSU and vice versa. There is a strong link between CSU and elevated levels of IgG antithyroid autoantibodies (AAbs), with most of a large number of studies reporting rates of ≥10%. Levels of IgG against thyroid peroxidase (TPO) are more often elevated in CSU than those of other IgG antithyroid AAbs (strong evidence). Levels of IgG antithyroid AAbs are more often elevated in adult patients with CSU than in children (strong evidence). Patients with CSU exhibit significantly higher levels of IgG antithyroid AAbs (strong evidence) and IgE-anti-TPO (weak evidence) than controls. Elevated IgG antithyroid AAbs in CSU are linked to the use of glucocorticoids (weak evidence) but not to disease duration or severity/activity, gender, age, or ASST response (inconsistent evidence). Thyroid dysfunction rates are increased in patients with CSU (strong evidence). Hypothyroidism and Hashimoto's thyroiditis are more common than hyperthyroidism and Graves' disease (strong evidence). Thyroid dysfunction is more common in adult patients with CSU than in children (strong evidence) and in female than in male patients with CSU (weak evidence). Urticaria including CSU is more prevalent in patients with thyroid autoimmunity than in controls (weak evidence). CSU can improve in response to treatment with levothyroxine or other thyroid drugs (strong evidence). Pathogenic mechanisms in CSU patients with thyroid autoimmunity may include IgE against autoantigens, immune complexes, and complement.

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Section: Resultsmentioning

confidence: 99%

Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: A systematic review

Kolkhir

Metz

Altrichter

et al. 2017

Allergy

149

118

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“…In contrast, IgE autoantibodies, such as those detected in about 50% of csU patients in our study, have not been described as relevant for the activation of mast cells in csU, except for in single patients. Ten years ago, Bar Sela and coworkers were able to detect such antibodies in the serum of a female patient who suffered from csU and Hashimoto's thyroiditis [14]. Subsequent studies using classic ELISA or RAST were unable to reproduce these findings in patients with csU and thyroid autoimmunity [15], probably due to interfering IgG autoantibodies [16] and the limited sensitivity of these assays.…”

Section: Discussionmentioning

confidence: 99%

IgE Mediated Autoallergy against Thyroid Peroxidase – A Novel Pathomechanism of Chronic Spontaneous Urticaria?

et al. 2011

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BackgroundChronic spontaneous urticaria (csU), which is characterized by recurrent episodes of mast cell-driven wheal and flare-type skin reactions, is often associated with elevated total IgE levels and thyroid autoimmunity. We speculate that some csU patients express IgE autoantibodies against thyroid antigens such as thyroid peroxidase (TPO), which could bind to skin mast cells and induce their activation.MethodsWe developed and used a site-directed human IgE capture ELISA to quantify IgE-anti-TPO. We used this assay and investigated csU patients (n = 478) and healthy control subjects (n = 127) for IgE-anti-TPO and then assessed IgE-anti-TPO-positive and -negative csU patients for clinical and serological differences.Principal FindingsCsU patients were found to express more than 2fold higher IgE-anti-TPO serum levels as compared to healthy control subjects (p<0.001). 54% of csU patients had serum levels higher than the cut off ( = 5 IU/ml). By distribution analyses we identified two distinct subpopulations of csU patients: 1) IgE-anti-TPOlow ( = 39%, IgE-anti-TPO: median 2.17 interquartile range 0.86–5.44, = comparable to healthy controls) and 2) IgE-anti-TPOhigh ( = 61%, IgE-anti-TPO: median 6.67, interquartile range 5.39–8.24). IgE-anti-TPO-positive and -negative csU patients had very similar distributions of age and gender as well as disease activity and duration. IgE-anti-TPO-positive csU patients exhibited significantly higher IgG-anti-TPO levels and lymphocyte counts as well as decreased C4 complement levels.ConclusionOur findings show that a sizeable subgroup of csU patients expresses IgE antibodies against thyroid peroxidase. These autoantibodies could cause “autoallergic” mast cell activation, a novel pathomechanism of chronic spontaneous urticaria.

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“…1). A role of type I autoimmunity in urticaria was postulated as early as 20 years ago, following the demonstration of IgE autoantibodies Int Arch Allergy Immunol 2020;181:321-333 DOI: 10.1159/000507218 against the thyroid microsomal antigen in the serum of a CSU patient [11]. Since then, many studies have further characterized the prevalence and pathogenic relevance of type I autoimmunity in CSU [12]: Thyroperoxidase (TPO) has been demonstrated to be a common and relevant autoallergen in CSU.…”

Section: Type I and Type Iib Autoimmunity: Emerging Endotypes Of Chromentioning

confidence: 99%

Urticaria: Collegium Internationale Allergologicum (CIA) Update 2020

Maurer

Eyerich

et al. 2020

Int Arch Allergy Immunol

139

141

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IgE antithyroid microsomal antibodies in a patient with chronic urticaria

Cited by 40 publications

References 5 publications

Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: A systematic review

Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: A systematic review

IgE Mediated Autoallergy against Thyroid Peroxidase – A Novel Pathomechanism of Chronic Spontaneous Urticaria?

Urticaria: Collegium Internationale Allergologicum (CIA) Update 2020

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