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Autoimmunity and complement in the pathogenesis of chronic urticaria

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Abstract

Chronic urticaria is a debilitating skin disease that is believed to have an underlying autoimmune etiology in 35% to 50% of cases. Patients with autoimmune urticaria have functional antibodies in their sera that release histamine from basophils and mast cells. The C5a component of complement is required for mast cell degranulation in this process and at least augments basophil histamine release. In this article, the evidence that is key to our understanding of autoimmunity and complement in the pathogenesis of a subset of patients with chronic urticaria is outlined. Some of the issues in testing for and treating autoimmune urticaria are discussed.

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References and Recommended Reading

  1. O’Donnell BF, Lawlor F, Simpson J, et al.: The impact of chronic urticaria on the quality of life. Br J Dermatol 1997, 136:197–201.

    Article  PubMed  CAS  Google Scholar 

  2. Grattan CE, Wallington TB, Warin RP, et al.: A serological mediator in chronic idiopathic urticaria--a clinical, immunological and histological evaluation. Br J Dermatol 1986, 114:583–590.

    Article  PubMed  CAS  Google Scholar 

  3. Sabroe RA, Grattan CE, Francis DM, et al.: The autologous serum skin test: a screening test for autoantibodies in chronic idiopathic urticaria. Br J Dermatol 1999, 140:446–452.

    Article  PubMed  CAS  Google Scholar 

  4. Grattan CE, Francis DM, Hide M, Greaves MW: Detection of circulating histamine releasing autoantibodies with functional properties of anti-IgE in chronic urticaria. Clin Exp Allergy 1991, 21:695–704.

    Article  PubMed  CAS  Google Scholar 

  5. Sabroe RA, Fiebiger E, Francis DM, et al.: Classification of anti-FcepsilonRI and anti-IgE autoantibodies in chronic idiopathic urticaria and correlation with disease severity. J Allergy Clin Immunol 2002, 110:492–499.

    Article  PubMed  CAS  Google Scholar 

  6. Hide M, Francis DM, Grattan CE, et al.: Autoantibodies against the high-afiity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 1993, 328:1599–1604.

    Article  PubMed  CAS  Google Scholar 

  7. Hide M, Francis DM, Grattan CE, et al.: The pathogenesis of chronic idiopathic urticaria: new evidence suggests an auto-immune basis and implications for treatment. Clin Exp Allergy 1994, 24:624–627.

    Article  PubMed  CAS  Google Scholar 

  8. Tanus T, Atkins PC, Zweiman B: Comparison of serum histamine-releasing activity and clinical manifestations in chronic idiopathic urticaria. Clin Diagn Lab Immunol 1996, 3:135–137.

    PubMed  CAS  Google Scholar 

  9. Tong LJ, Balakrishnan G, Kochan JP, et al.: Assessment of autoimmunity in patients with chronic urticaria. J Allergy Clin Immunol 1997, 99:461–465.

    Article  PubMed  CAS  Google Scholar 

  10. Niimi N, Francis DM, Kermani F, et al.: Dermal mast cell activation by autoantibodies against the high afiity IgE receptor in chronic urticaria. J Invest Dermatol 1996, 106:1001–1006.

    Article  PubMed  CAS  Google Scholar 

  11. Ferrer M, Nakazawa K, Kaplan AP: Complement dependence of histamine release in chronic urticaria. J Allergy Clin Immunol 1999, 104:169–172.

    Article  PubMed  CAS  Google Scholar 

  12. Asero R, Lorini M, Chong SU, et al.: Assessment of histaminereleasing activity of sera from patients with chronic urticaria showing positive autologous skin test on human basophils and mast cells. Clin Exp Allergy 2004, 34:1111–1114.

    Article  PubMed  CAS  Google Scholar 

  13. Grattan C, Francis D: Autoimmune urticaria. Adv Dermatol 1999, 12:311–340.

    Google Scholar 

  14. Grattan CE, Francis DM, Slater NG, et al.: Plasmapheresis for severe, unremitting, chronic urticaria. Lancet 1992, 339:1078–1080.

    Article  PubMed  CAS  Google Scholar 

  15. Luquin E, Kaplan AP, Ferrer M: Increased responsiveness of basophils of patients with chronic urticaria to sera but hypo-responsiveness to other stimuli. Clin Exp Allergy 2005 8, 35, 456–460. A groundbreaking study that identifies an abnormality in the basophils of patients with autoimmune and nonautoimmune urticaria.

    Article  Google Scholar 

  16. Zweiman B, Valenzano M, Atkins PC, et al.: Characteristics of histamine-releasing activity in the sera of patients with chronic idiopathic urticaria. J Allergy Clin Immunol 1996, 98:89–98.

    Article  PubMed  CAS  Google Scholar 

  17. Fiebiger E, Hammerschmid F, Stingl G, Maurer D:Anti-FcepsilonRIalpha autoantibodies in autoimmunemediated disorders. Identfiation of a structure-function relationship. J Clin Invest 1998, 101:243–251.

    PubMed  CAS  Google Scholar 

  18. Kikuchi Y, Kaplan AP: Mechanisms of autoimmune activation of basophils in chronic urticaria. J Allergy Clin Immunol 2001, 107:1056–1062.

    Article  PubMed  CAS  Google Scholar 

  19. Oskeritzian CA, Zhao W, Min HK, et al.: Surface CD88 functionally distinguishes the MCTC from the MCT type of human lung mast cell. J Allergy Clin Immunol 2005, 115:1162–1168.

    Article  PubMed  CAS  Google Scholar 

  20. Tedeschi A, Comi AL, Lorini M, et al.: Autologous serum skin test reactivity in patients with non-allergic asthma. Clin Exp Allergy 2005, 35:849–853.

    Article  PubMed  CAS  Google Scholar 

  21. Fiebiger E, Maurer D, Holub H, et al.: Serum IgG autoantibodies directed against the alpha chain of Fc epsilon RI: a selective marker and pathogenetic factor for a distinct subset of chronic urticaria patients? J Clin Invest 1995, 96:2606–2612.

    Article  PubMed  CAS  Google Scholar 

  22. Soundararajan S, Kikuchi Y, Joseph K, Kaplan AP: Functional assessment of pathogenic IgG subclasses in chronic autoimmune urticaria. J Allergy Clin Immunol 2005, 115:815–821.

    Article  PubMed  CAS  Google Scholar 

  23. Horn MP, Pachlopnik JM, Vogel M, et al.: Conditional autoimmunity mediated by human natural anti-Fc(epsilon)RIalpha autoantibodies? FASEB J 2001, 15:2268–2274. Evidence for the existence of non-functional autoantibodies against FcεRIα in healthy subjects and a potential explanation for development of autoimmunity

    Article  PubMed  CAS  Google Scholar 

  24. Kaplan AP: Chronic urticaria: pathogenesis and treatment. J Allergy Clin Immunol 2004,. 114:465–474; quiz 475. An interesting review that discusses current issues

    Article  PubMed  CAS  Google Scholar 

  25. Ferrer M, Luquin E, Kaplan AP: IL3 effect on basophils histamine release upon stimulation with chronic urticaria sera. Allergy 2003, 58:802–807.

    Article  PubMed  CAS  Google Scholar 

  26. De Swerdt A, Van Den Keybus C, Kasran A, et al.: Detection of basophil-activating IgG autoantibodies in chronic idiopathic urticaria by induction of CD63. J Allergy Clin Immunol 2005, 116:662–667.

    Article  PubMed  CAS  Google Scholar 

  27. Kaplan AP: Comments regarding ldAssessment of histamine-releasing activity of sera from patients with chronic urticaria showing positive autologous skin test on human basophils and mast cells” by Asero et al. Clin Exp Allergy 2004, 34:1803; author reply 1804–1805.

    Article  PubMed  CAS  Google Scholar 

  28. Sabroe RA, Poon E, Orchard GE, et al.: Cutaneous ifimmatory cell ifitrate in chronic idiopathic urticaria: comparison of patients with and without anti-FcepsilonRI or anti-IgE autoantibodies. J Allergy Clin Immunol 1999, 103:484–493.

    Article  PubMed  CAS  Google Scholar 

  29. Grattan CE, Walpole D, Francis DM, et al.: Flow cytometric analysis of basophil numbers in chronic urticaria: basopenia is related to serum histamine releasing activity. Clin Exp Allergy 1997, 27:1417–1424.

    PubMed  CAS  Google Scholar 

  30. Grattan CE, Sabroe R A, Greaves MW: Chronic urticaria. J Am Acad Dermatol 2002, 46:645–657; quiz 657–660.

    Article  PubMed  Google Scholar 

  31. Leznoff A, Josse RG, Denburg J, Dolovich J: Association of chronic urticaria and angioedema with thyroid autoimmunity. Arch Dermatol 1983, 119:636–640.

    Article  PubMed  CAS  Google Scholar 

  32. Leznoff A, Sussman GL: Syndrome of idiopathic chronic urticaria and angioedema with thyroid autoimmunity: a study of 90 patients. J Allergy Clin Immunol 1989, 84:66–71.

    Article  PubMed  CAS  Google Scholar 

  33. Lanigan SW, Short P, Moult P: The association of chronic urticaria and thyroid autoimmunity. Clin Exp Dermatol 1987, 12:335–338.

    Article  PubMed  CAS  Google Scholar 

  34. Turktas I, Gokcora N, Demirsoy S, et al.: The association of chronic urticaria and angioedema with autoimmune thyroiditis. Int J Dermatol 1997, 36:187–190.

    Article  PubMed  CAS  Google Scholar 

  35. Levy Y, Segal N, Weintrob N, Danon YL: Chronic urticaria: association with thyroid autoimmunity. Arch Dis Child 2003, 88:517–519.

    Article  PubMed  CAS  Google Scholar 

  36. Kikuchi Y, Fann T, Kaplan AP: Antithyroid antibodies in chronic urticaria and angioedema. J Allergy Clin Immunol 2003, 112:218.

    Article  PubMed  Google Scholar 

  37. Bakos N, Hillander M: Comparison of chronic autoimmune urticaria with chronic idiopathic urticaria. Int J Dermatol 2003, 42:613–615.

    Article  PubMed  Google Scholar 

  38. Fusari A, Colangelo C, Bonifazi F, Antonicelli L: The autologous serum skin test in the follow-up of patients with chronic urticaria. Allergy 2005, 60:256–258.

    Article  PubMed  CAS  Google Scholar 

  39. Ryhal B, DeMera RS, Shoenfeld Y, et al.: Are autoantibodies present in patients with subacute and chronic urticaria? J Investig Allergol Clin Immunol 2001, 11:16–20.

    PubMed  CAS  Google Scholar 

  40. Asero R, Lorini M, Tedeschi A: Association of chronic urticaria with thyroid autoimmunity and Raynaud phenomenon with anticentromere antibodies. J Allergy Clin Immunol 2003, 111:1129–1130.

    Article  PubMed  CAS  Google Scholar 

  41. Hizal M, Tuzun B, Wolf R, Tuzun Y: The relationship between Helicobacter pylori IgG antibody and autologous serum test in chronic urticaria. Int J Dermatol 2000, 39:443–445.

    Article  PubMed  CAS  Google Scholar 

  42. Greaves MW: Chronic idiopathic urticaria and H pylori: not directly causative but could there be a link? ACI International 2001, 23–26.

  43. Owen CM, Chalmers RJ, O’Sullivan T, Grifihs CE:. A systematic review of antistreptococcal interventions for guttate and chronic plaque psoriasis. Br J Dermatol 2001, 145:886–890.

    Article  PubMed  CAS  Google Scholar 

  44. O’Donnell BF, O’Neill CM, Francis DM, et al.: Human leucocyte antigen class II associations in chronic idiopathic urticaria. Br J Dermatol 1999, 140:853–858.

    Article  PubMed  CAS  Google Scholar 

  45. Sabroe RA, Seed PT, Francis DM, et al.: Chronic idiopathic urticaria: comparison of the clinical features of patients with and without anti-FcepsilonRI or anti-IgE autoantibodies. J Am Acad Dermatol 1999, 40:443–450.

    Article  PubMed  CAS  Google Scholar 

  46. Grattan CE: Autoimmune urticaria. Immunol Allergy Clin North Am 2004, 24:163–181, v. A comprehensive review.

    Article  PubMed  Google Scholar 

  47. Bagenstose SE, Levin L, Bernstein JA: The addition of zafirlukast to cetirizine improves the treatment of chronic urticaria in patients with positive autologous serum skin test results. J Allergy Clin Immunol 2004, 113:134–140.

    Article  PubMed  CAS  Google Scholar 

  48. Grattan CE, O’Donnell BF, Francis DM, et al.: Randomized double-blind study of cyclosporin in chronic ldidiopathic” urticaria. Br J Dermatol 2000, 143:365–372.

    Article  PubMed  CAS  Google Scholar 

  49. Marsland AM, Soundararajan S, Joseph K, Kaplan AP:Effects of calcineurin inhibitors on an in vitro assay for chronic urticaria. Clin Exp Allergy 2005, 35:554–559. This study shows that calcineurin inhibitors inhibit part of the basophil histamine release assay and may potentially form the basis for an assay to determine treatment options for individual patients

    Article  PubMed  CAS  Google Scholar 

  50. Hennino A, Berard F, Guillot I, et al.: Pathophysiology of urticaria. Clin Rev Allergy Immunol 2006, 30:3–12.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, University of Manchester School of Medicine, Hope Hospital, Stott Lane, M6 8HD, Salford, Manchester, UK

    Alexander M. Marsland MRCP (UK)

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  1. Alexander M. Marsland MRCP (UK)
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Correspondence to Alexander M. Marsland MRCP (UK).

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Marsland, A.M. Autoimmunity and complement in the pathogenesis of chronic urticaria. Curr Allergy Asthma Rep 6, 265–269 (2006). https://doi.org/10.1007/s11882-006-0058-8

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  • DOI: https://doi.org/10.1007/s11882-006-0058-8

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