Pathophysiology of chronic urticaria

Allergic skin diseases

“…43,44 The most significant recent conceptual advances in our understanding of CU have been (1) the deepening appreciation that there is evidence of autoimmunity for a substantial number of patients and (2) a better understanding of the implications of diminished basophil function. [45][46][47][48] Nevertheless, it is still unclear whether the detected autoimmune phenomena or defects in basophil signaling contribute to the pathophysiology of CU and, if they do participate, what pathways are involved. Therapy of CU has also advanced, with more evidence supporting the efficacy of immunomodulatory drugs.…”

“…The idiopathic cases, chronic idiopathic urticaria (CIU), include 30% to 60% who have an autoimmune phenotype, but the evidence that autoimmunity is pathophysiologic in the same way that physical stimuli are considered directly related to the development of hives is not generally accepted. 44,47,52 For the purpose of this discussion, patients with autoantibodies will be considered to have idiopathic urticaria with evidence of autoimmunity.…”

“…The immediate products are responsible for pruritus, swelling, and erythema, whereas the later products lead to an influx of inflammatory cells. 47 Lesions of acute urticaria are characterized by subcutaneous edema with widened dermal papillae and rare inflammatory cells. Lesions of CU, in addition to the presence of edema, are characterized by a perivascular inflammatory infiltrate consisting of CD4 1 and CD8 1 T lymphocytes, eosinophils, basophils, and neutrophils.…”

“…A small number of patients with urticarial vasculitis present with atypical clinical features and have histologic evidence of vascular destruction. 47 In small subgroups of patients, CU is driven by IgE/allergen interactions stimulating the high-affinity receptor for IgE (FceRI) or by physical stimuli acting through nonspecific pathways. For CIU, the pathophysiology is still unclear.…”

Chronic Urticarial in Childhood. Immune Pathology of Chronic Urticarial in Children (Part I)

“…Считается, что тучные клетки гипер-реактивны в ответ на неиммунную стимуляцию. По-видимому, гиперреактивность тучных клеток в ответ на неиммунные стимулы клинически мо-жет проявляться обострением крапивницы под воздействием различных неспецифических триг-геров [24].…”