Improvement of Chronic Idiopathic Urticaria With Levothyroxine: A Case Report and Review of Literature

Shahbaz, Amir; Senapathi, Sri Harshavardhan; Aziz, Kashif; Umair, Muhammad; Khalid, Amna; Sachmechi, Issac

doi:10.7759/cureus.3209

Cited by 2 publications

(1 citation statement)

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“…Thirdly, HT may hint to the presence of aiCSU, which is usually more severe and resistant to omalizumab treatment. 4 37 38 Furthermore, treatment of hypothyroidism with levothyroxine might be associated with improvement of CSU, 17 39 although some studies did not confirm this. 40 …”

Section: Discussionmentioning

confidence: 99%

Autoimmune Diseases Are Linked to Type IIb Autoimmune Chronic Spontaneous Urticaria

Kolkhir

Altrichter

Asero

et al. 2021

Allergy Asthma Immunol Res

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Purpose Patients with chronic spontaneous urticaria (CSU) have an increased risk for comorbid autoimmune diseases. In this retrospective multicenter study of CSU patients, we evaluated clinical and laboratory features of CSU associated with a higher risk of comorbid autoimmune diseases. Methods We analyzed records of CSU patients (n = 1,199) for a history or presence of autoimmune diseases. Patients were diagnosed with type IIb autoimmune CSU (aiCSU) if all 3 tests were positive: autologous serum skin test (ASST), basophil histamine release assay (BHRA) and/or basophil activation test (BAT), and IgG autoantibodies against FcεRIα/IgE detected by immunoassay. Results Twenty-eight percent of CSU patients had at least 1 autoimmune disease. The most prevalent autoimmune diseases were Hashimoto's thyroiditis (HT) (≥ 21%) and vitiligo (2%). Two percent of CSU patients had ≥ 2 autoimmune diseases, most frequently HT plus vitiligo. Comorbid autoimmune diseases, in patients with CSU, were associated with female sex, a family history of autoimmune diseases, and higher rates of hypothyroidism and hyperthyroidism ( P < 0.001). Presence of autoimmune diseases was linked to aiCSU ( P = 0.02). The risks of having autoimmune diseases were 1.7, 2.9 and 3.3 times higher for CSU patients with a positive ASST, BHRA and BAT, respectively. In CSU patients, markers for autoimmune diseases, antinuclear antibodies and/or IgG anti-thyroid antibodies were associated with non-response to omalizumab treatment ( P = 0.013). Conclusions In CSU, autoimmune diseases are common and linked to type IIb autoimmune CSU. Our results suggest that physicians assess and monitor all adult patients with CSU for signs and symptoms of common autoimmune diseases, especially HT and vitiligo.

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