Intravenous immunoglobulin in autoimmune chronic urticaria

Abstract

Histamine releasing autoantibodies play a central role in the pathogenesis of chronic urticaria (CU) in approximately 30% of affected patients. We investigated the therapeutic effect of high-dose intravenous immunoglobulin (IVIG) on disease activity in patients with severe CU of autoimmune aetiology. Autoimmune urticaria was diagnosed by the development of a weal-and-flare reaction to the intradermal injection of autologous serum and by serum-induced histamine release from the basophil leucocytes of healthy donors in vitro. Ten patients with severe, autoimmune CU, poorly responsive to conventional treatment, were treated with IVIG 0.4 g/kg per day for 5 days. The outcome on cutaneous wealing and itch was monitored using urticaria activity scores, visual analogue scales and autologous intradermal serum tests. Clinical benefit was noted in nine of 10 patients: three patients continue in prolonged complete remissions (3 years follow-up), two had temporary complete remissions, and symptoms in four patients improved subsequent to treatment. There was significant improvement in the urticaria activity scores and visual analogue scores at 2 (P < 0.01) and 6 weeks (P < 0.01) post-IVIG compared with the baseline values (Wilcoxon matched pairs). The diminution in urticarial activity in the majority of patients corresponded with a reduced weal-and-flare response to the intradermal injection of autologous post-treatment serum compared with the pretreatment serum. Minor side-effects were common, but there were no serious or long-term adverse effects. IVIG represents a novel therapeutic option in selected patients with recalcitrant CU associated with histamine releasing autoantibodies.

Randomized placebo-controlled trial comparing desloratadine and montelukast in monotherapy and desloratadine plus montelukast in combined therapy for chronic idiopathic urticaria

“…H 1 -receptor antagonists are the first-choice treatment for patients with CIU, 1 but unfortunately, some patients do not benefit from these agents. 1,2,[4][5][6][7][8] Then the combination with a second agent is required, especially if H 1 -blockers are only partially effective.…”

A High-Affinity Natural Autoantibody from Human Cord Blood Defines a Physiologically Relevant Epitope on the FcεRIα

“…Human autoantibodies specific to either Fc⑀RI␣ or IgE have been ascribed a central role in up to 30% of CU cases (50). Our former data suggested that cross-linking anti-Fc⑀RI␣ Abs are also present in healthy individuals (11).…”

“…Additional mechanisms protecting from autoreactivity to Fc⑀RI␣ may include antiidiotypic Abs to the anti-Fc⑀RI␣ Abs. Indeed, the symptoms of CU could be alleviated in clinical trials (50) with IVIg, which is hypothesized to contain natural Abs (45,51) and is believed to restore an unbalanced anti-idiotypic network (59). In addition, the exposed receptor is likely to be protected from CBM␣8-like Abs FIGURE 5.…”

Treatment of Chronic Urticaria

“…However, the number of infusions needed to achieve clinical control greatly varied among patients (96). In another study, ten patients with positive circulating antiFcERI or antiIgE antibodies were given IVIG 2 g/kg for 5 days and this therapy was efficient in nine patients and induced prolonged remission in three patients (97). One case report describes good result with low dose (0.2 g/kg) over one day.…”