Update on chronic urticaria: focusing on mechanisms

Młynek, A.; Maurer, Marcus; Zalewska, Anna

doi:10.1097/aci.0b013e32830f9119

Cited by 24 publications

(13 citation statements)

References 38 publications

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“…Positivity to autologous serum test is found in one-third CU cases, known as autoreactive chronic urticaria (ACU), in which IgG antibodies play an important part by interacting with the α chain of the high-affinity IgE receptor (FcεRIα) [6], [7], [8], [10]. Although the prevalence and significance of ASST in CU has been widely investigated, there is considerable variation in the positive rate of ASST in different studies [4], [7], [8], [9], [10], [11], [12].…”

Section: Discussionmentioning

confidence: 99%

“…Chronic spontaneous urticaria (CSU), also known as chronic idiopathic urticaria, is characterized by spontaneous occurrence of wheals without an obvious stimulus lasting for more than 6 weeks [1], [2]. Pathogenesis of CSU is unclear and possible causes may include chronic infections, allergy to certain food or food additives, anxiety, and autoantibody production against immunoglobulin E (IgE) receptor [1], [2], [3], [4], [5], [6].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Autologous Serum Skin Test and Skin Prick Test Reactivity to House Dust Mite in Patients with Chronic Spontaneous Urticaria

et al. 2013

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BackgroundChronic spontaneous urticaria (CSU) is a common skin disorder with etiology that is not well understood.MethodsIn this study, we evaluated the prevalence of autologous serum skin test (ASST) and skin prick testing (SPT) to house dust mite (HDM) in 862 CSU cases in China. Clinical features, courses and treatment responses were also recorded.ResultsThe prevalence of positive ASST was 46.3%, and patients aged 30–39 years had the highest positive rate (52.1%). Positive SPT to HDM was seen in 153 patients (17.7%) with the highest positive rate (34.2%) in patients aged 20 or less. Patients with positive ASST had higher urticaria activity scores (UAS) (4.18±0.65 vs. 3.67±0.53) but lower positive rates of HDM (24.6% vs. 37.6%), as compared with those with negative ASST (odds ratio (OR) 1.84, 95% CI 1.38–2.47). Patients could be categorized into four groups based on the results of ASST and SPT to HDM and patients with positive ASST and positive SPT to HDM had the highest disease activity scores, experienced higher frequencies of angioedema, diseases duration, and required higher dosage of loratadine every month, compared with other subgroups (P<0.0001).ConclusionsPatients with CSU showed varied responses of positive ASST and varied sensitivity to HDM, Patients with positive ASST and/or positive SPT had more disease activity compared with patients with negative ASST and/or negative SPT. Further classification can be made based on the result of SPT and ASST.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of Autologous Serum Skin Test and Skin Prick Test Reactivity to House Dust Mite in Patients with Chronic Spontaneous Urticaria

et al. 2013

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“…Mast cells may therefore contribute to disease development either directly or indirectly via the production of specific mediators. For example, mast cell-released histamine plays a major role in the generation of skin rash, wheals, and hives that become apparent in urticaria (Mlynek et al, 2008). In contact hypersensitivity, mast cell-produced TNF may play a role in the initiation and translation of the T cell mediated delayed type hypersensitivity responses (Nakae et al, 2005).…”

Section: Pathological Role Of Mast Cells In Inflammatory Diseasesmentioning

confidence: 99%

Mast cells as cellular sensors in inflammation and immunity

et al. 2011

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Mast cells are localized in tissues. Intense research on these cells over the years has demonstrated their role as effector cells in the maintenance of tissue integrity following injury produced by infectious agents, toxins, metabolic states, etc. After stimulation they release a sophisticated array of inflammatory mediators, cytokines, and growth factors to orchestrate an inflammatory response. These mediators can directly initiate tissue responses on resident cells, but they have also been shown to regulate other infiltrating immune cell functions. Research in recent years has revealed that the outcome of mast cell actions is not always detrimental for the host but can also limit disease development. In addition, mast cell functions highly depend on the physiological context in the organism. Depending on the genetic background, strength of the injurious event, the particular microenvironment, mast cells direct responses ranging from pro- to anti-inflammatory. It appears that they have evolved as cellular sensors to discern their environment in order to initiate an appropriate physiological response either aimed to favor inflammation for repair or at the contrary limit the inflammatory process to prevent further damage. Like every sophisticated machinery, its dysregulation leads to pathology. Given the broad distribution of mast cells in tissues this also explains their implication in many inflammatory diseases.

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“…These symptoms are brought about by activated skin mast cells and their subsequent release of histamine and other proinflammatory mediators [2]. The underlying causes and the mechanisms of mast cell activation in most types of urticaria are largely unknown and remain to be identified.…”

Section: Introductionmentioning

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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Update on chronic urticaria: focusing on mechanisms

Cited by 24 publications

References 38 publications

Evaluation of Autologous Serum Skin Test and Skin Prick Test Reactivity to House Dust Mite in Patients with Chronic Spontaneous Urticaria

Evaluation of Autologous Serum Skin Test and Skin Prick Test Reactivity to House Dust Mite in Patients with Chronic Spontaneous Urticaria

Mast cells as cellular sensors in inflammation and immunity

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

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