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Chronic idiopathic urticaria and Graves’ disease

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Abstract

Chronic urticaria is a common condition characterized by recurrent episodes of mast cell-driven wheal and flare-type skin reactions lasting for more than 6 weeks. In about 75% of cases, the underlying causes remain unknown, and the term chronic idiopathic urticaria (CIU) is used to emphasize that wheals develop independently of identified external stimuli. Although CIU affects about 1.0% of the general population, its etiopathogenesis is not yet well understood. It is now widely accepted that in many cases CIU should be regarded as an autoimmune disorder caused by circulating and functionally active IgG autoantibodies specific for the IgE receptor (FceRI) present on mast cells and basophils or for IgE itself. The well-known association of CIU with other autoimmune processes/diseases represents further indirect evidence of its autoimmune origin. Autoimmune thyroid diseases, especially autoimmune thyroiditis, represent the most frequently investigated diseases in association with CIU. Here we review this topic with particular regard to the association between Graves’ disease and CIU. The possible pathogenetic mechanisms and the clinical implications of such an association are discussed.

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References

  1. Zuberbier T, Asero R, Bindslev-Jensen C, et al. EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy 2009, 64: 1417–26.

    Article  PubMed  Google Scholar 

  2. Kulthanan K, Jiamton S, Thumpimukvatana N, Pinkaew S. Chronic idiopathic urticaria: prevalence and clinical course. J Dermatol 2007, 34: 294–301.

    Article  PubMed  Google Scholar 

  3. Najib U, Sheikh J. The spectrum of chronic urticaria. Allergy, Asthma Proc 2009, 30: 1–10.

    Article  Google Scholar 

  4. Maurer M, Weller K, Bindslev-Jensen C, et al. Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report. Allergy 2011, 66: 317–30.

    Article  PubMed  Google Scholar 

  5. Greaves MW, Plummer VM, McLaughlan P, Stanworth DR. Serum and cell-bound IgE in chronic urticaria. Clin Allergy 1974, 4: 265–71.

    Article  PubMed  Google Scholar 

  6. Grattan CEH, Wallington TB, Warin RP. A serological mediator in chronic idiopathic urticaria: A clinical immunological and histological evaluation. Br J Dermatol 1986, 114: 583–90.

    Article  PubMed  Google Scholar 

  7. Grattan CEH, Francis DM, Hide M, et al. Detection of circulating histamine releasing autoantibodies with functional properties of anti-IgE in chronic urticaria. Clin Exp Allergy 1991, 21: 695–704.

    Article  PubMed  Google Scholar 

  8. Hide M, Francis DM, Grattan C, Hakimi J, Kochan JP, Greaves MW. Autoantibodies against the high affinity IgE receptor as a cause for histamine release in chronic urticaria. N Engl J Med 1993, 328: 1599–604.

    Article  PubMed  Google Scholar 

  9. Fiebiger E, Maurer D, Holub H, et al. Serum IgG autoantibodies directed against the a-chain of FceRI: a selective marker and pathogenetic factor for a distinct subset of chronic urticaria and pathogenetic factor for a distinct subset of chronic urticaria patients? J Clin Invest 1995, 96: 2606–12.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Niimi N, Francis DM, Kermani F, et al. Dermal mast cell activation by autoantibodies against the high affinity IgE receptor in chronic urticaria. J Invest Dermatol 1996, 106: 1001–6.

    Article  PubMed  Google Scholar 

  11. Fiebiger E, Hammerschmid F, Stingl G, Maurer D. Anti-FcepsilonRlalpha autoantibodies in autoimmune-mediated disorders. Identification of a structure-function relationship. J Clin Invest 1998, 101: 243–51.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Zweiman B, Valenzano M, Atkins PC, Tanus T, Getsy JA. Characteristics of histamine-releasing activity in the sera of patients with chronic idiopathic urticaria. J Allergy Clin Immunol 1996, 98: 89–98.

    Article  PubMed  Google Scholar 

  13. Ferrer M, Nazakawa K, Kaplan AP. Complement dependence of histamine release in chronic urticaria. J Allergy Clin Immunol 1999, 104: 169–72.

    Article  PubMed  Google Scholar 

  14. Kikuchi Y, Kaplan AP. Mechanisms of autoimmune activation of basophils in chronic urticaria. J Allergy Clin Immunol 2001, 107: 1056–62.

    Article  PubMed  Google Scholar 

  15. Kikuchi Y, Kaplan AP. A role for C5a in augmenting IgG-dependent histamine release from basophils in chronic urticaria. J Allergy Clin Immunol 2002, 109: 114–8.

    Article  PubMed  Google Scholar 

  16. 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: 492–9.

    Article  PubMed  Google Scholar 

  17. Confino-Cohen R, Chodick G, Shalev V, Leshno M, Kimhi O, Goldberg A. Chronic urticaria and autoimmunity: associations found in a large population study. J Allergy Clin Immunol 2012, 129: 1307–13.

    Article  PubMed  Google Scholar 

  18. Bagnasco M, Minciullo PL, Schiavo M, Saraceno G, Gangemi S, Benvenga S. Urticaria and thyroid autoimmunity. Thyroid 2011, 21: 401–10.

    Article  PubMed  Google Scholar 

  19. Leznoff A, Josse RG, Denberg J, Dolovich J. Association of chronic urticaria and angioedema with thyroid autoimmunity. Arch Dermatol 1983, 119: 636–40.

    Article  PubMed  Google Scholar 

  20. Leznoff A, Sussman G. 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  Google Scholar 

  21. Atta AM, Rodrigues MZA, Sousa CP, Medeiros Junior M, Sousa-Atta MLB. Autoantibody production in chronic idiopathic urticaria is not associated with Helicobacter pylori infection. Braz J Med Biol Res 2004, 37: 13–7.

    PubMed  Google Scholar 

  22. Gangemi S, Saitta S, Lombardo G, Patafi M, Benvenga S. Serum thyroid autoantibodies in patients with idiopathic either acute or chronic urticaria. J Endocrinol Invest 2009, 32: 107–10.

    PubMed  Google Scholar 

  23. Antiga E, Volpi W, Fabbri P, Caproni M. Re: Serum thyroid autoantibodies in patients with idiopathic either acute or chronic urticaria. J Endocrinol Invest 2010, 33: 357.

    PubMed  Google Scholar 

  24. Aamir IS, Tauheed S, Majid F, Atif A. Frequency of autoimmune thyroid disease in chronic urticaria. J Coll Physicians Surg Pak 2010, 20: 158–61.

    PubMed  Google Scholar 

  25. Doutre MS. Chronic urticaria and thyroid auto-immunity. Clin Rev Allergy Immunol 2006, 30: 31–7.

    Article  PubMed  Google Scholar 

  26. Mozena JD, Tiñana A, Negri J, Steinke JW, Borish L. Lack of a role for cross-reacting anti-thyroid antibodies in chronic idiopathic urticaria. J Invest Dermatol 2010, 130: 1860–5.

    Article  PubMed  Google Scholar 

  27. Altrichter S, Peter HJ, Pisarevskaja D, Metz M, Martus P, Maurer M. IgE mediated autoallergy against thyroid peroxidase—a novel pathomechanism of chronic spontaneous urticaria? PLoS One 2011, 6: e14794.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Bar-Sela S, Reshef T, Mekori YA. IgE antithyroid microsomal antibodies in a patient with chronic urticaria. J Allergy Clin Immunol 1999, 103: 1216–7.

    Article  PubMed  Google Scholar 

  29. Tedeschi A, Lorini M, Asero R. Anti-thyroid peroxidase IgE in patients with chronic urticaria. J Allergy Clin Immunol 2001, 108: 467–8.

    Article  PubMed  Google Scholar 

  30. Concha LB, Chang CC, Szema AM, Dattwyler RJ, Carlson HE. IgE antithyroid antibodies in patients with Hashimoto’s disease and chronic urticaria. Allergy Asthma Proc 2004, 25: 293–6.

    PubMed  Google Scholar 

  31. Haapala AM, Hyoty H, Parkkonen P, Mustonen J, Soppi E. Antibody reactivity against thyroid peroxidase and myeloperoxidase in autoimmune thyroiditis and systemic vasculitis. Scand J Immunol 1997, 46: 78–85.

    Article  PubMed  Google Scholar 

  32. Molnar I, Kelemen E, Somogyine-Vari E. Antigen mimicry between aeroallergens and thyroid antigens can modify the levels of thyroid hormones and antibodies in thyroid autoimmunity. Endocrine Abstracts 15th International & 14th European Congress of Endocrinology (ICE/ECE 2012) 2012, vol. 29, P1606.

    Google Scholar 

  33. Aversano M, Caiazzo P, Iorio G, Ponticiello L, Laganá B, Leccese F. Improvement of chronic idiopathic urticarial with L-thyroxine: a new TSH role in immune response? Allergy 2005, 60: 489–93.

    Article  PubMed  Google Scholar 

  34. Meneghetti R, Gerarduzzi T, Barbi E, Ventura A. Chronic urticaria and celiac disease. Arch Dis Child 2004, 89: 293.

    Article  PubMed Central  PubMed  Google Scholar 

  35. 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: 1129–30.

    Article  PubMed  Google Scholar 

  36. Ryhal B, DeMera RS, Shoenfeld Y, Peter JB, Gershwin ME. Are autoantibodies present in patients with subacute and chronic urticaria? J Investig Allergol Clin Immunol 2001, 11: 16–20.

    PubMed  Google Scholar 

  37. Chapman EW, Maloof F. Bizzarre clinical manifestations of hyperthyroidism. N Engl J Med 1956, 254: 1–5.

    Article  PubMed  Google Scholar 

  38. Caravati CM, Richardson DR, Wood BT, Cawley EP. Cutaneous manifestations of hyperthyroidism. South Med J 1969, 62: 1127–30.

    Article  PubMed  Google Scholar 

  39. Isaacs NJ, Ertel NH. Urticaria and pruritus: uncommon manifestations of hyperthyroidism. J Allergy Clin Immunol 1971, 48: 73–81.

    Article  PubMed  Google Scholar 

  40. Small P, Lerman S. Hyperthyroidism and polycythemia vera with chronic urticaria and angioedema. Ann Allergy 1981, 46: 256–9.

    PubMed  Google Scholar 

  41. Cailleba A, Andre P, Thieblot P, Lauras H, Moinade S. Rare association of urticaria and Basedow’s disease. Presse Med 1984, 13: 942.

    PubMed  Google Scholar 

  42. Altus P, Blandon R, Wallach PM, Flannery MT. Case report: the spectrum of autoimmune thyroid disease with urticaria. Am J Med Sci 1993, 306: 379–80.

    Article  PubMed  Google Scholar 

  43. Henderson CA, Highet AS. Urticaria associated with tyrotoxicosis. Clin Exp Dermatol 1995, 20: 173–4.

    Article  PubMed  Google Scholar 

  44. Collet E, Petit JM, Lacroix M, Bensa AF, Morvan C, Lambert D. Chronic urticaria and autoimmune thyroid diseases. Ann Dermatol Venereol 1995, 122: 413–6.

    PubMed  Google Scholar 

  45. Gaig P, García-Ortega P, Enrique E, Richart C. Successful treatment of chronic idiopathic urticaria associated with thyroid autoimmunity. J Investig Allergol Clin Immunol 2000, 10: 342–5.

    PubMed  Google Scholar 

  46. Irani C, Gordon ND, Zweiman B, Levinson AI. Chronic urticaria/angioedema and Graves’ disease: coexistence of 2 antireceptor antibody-mediated diseases. J Allergy Clin Immunol 2001, 108: 874.

    Article  PubMed  Google Scholar 

  47. Carvalho P. In which circumstances does the description of an etiology affect the treatment and the course of chronic urticaria? Ann Dermatol Venereol 2003, 130: 1S121–8.

    PubMed  Google Scholar 

  48. Verneuil L, Leconte C, Ballet JJ, et al. Association between Chronic Urticaria and Thyroid Autoimmunity: A Prospective Study Involving 99 Patients. Dermatology 2004, 208: 98–103.

    Article  PubMed  Google Scholar 

  49. Caproni M, Volpi W, Giomi B, Cardinali C, Antiga E, Melani L, Dagata A, Fabbri P. Chronic idiopathic and chronic autoimmune urticaria: clinical and immunopathological features of 68 subjects. Acta Derm Venereol 2004, 84: 288–90.

    Article  PubMed  Google Scholar 

  50. Asero R, Orsatti A, Tedeschi A, Lorini M. Autoimmune chronic urticaria associated with type 1 diabetes and Graves’ disease. J Allergy Clin Immunol 2005, 115: 1088–9.

    Article  PubMed  Google Scholar 

  51. Cebeci F, Tanrikut A, Topcu E, Onsun N, Kurtulmus N, Uras AR. Association between chronic urticaria and thyroid autoimmunity. Eur J Dermatol 2006, 16: 402–5.

    PubMed  Google Scholar 

  52. Monge C, Demarco P, Burman KD, Wartofsky L. Autoimmune thyroid disease and chronic urticaria. Clin Endocrinol 2007, 67: 473–5.

    Article  Google Scholar 

  53. Bansal AS, Hayman GR. Graves’ disease associated with chronic idiopathic urticaria: 2 case reports. J Investig Allergol Clin Immunol 2009, 19: 54–6.

    PubMed  Google Scholar 

  54. Cooper DS Hyperthyroidism. Lancet 2003, 362: 459–68.

    Article  PubMed  Google Scholar 

  55. Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003, 348: 2646–55.

    Article  PubMed  Google Scholar 

  56. Yamada T, Sato A, Komiya I, et al. An elevation of serum immunoglobulin E provides a new aspect of hyperthyroid Graves’ disease. J Clin Endocrinol Metab 2000, 85: 2775–8.

    PubMed  Google Scholar 

  57. Komiya I, Yamada T, Sato A, Kouki T, Nishimori T, Takasu N. Remission and recurrence of hyperthyroid Graves’ disease during and after thiamazole treatment when assessed by IgE and interleukin-13. J Clin Endocrinol Metab 2001, 86: 3540–4.

    PubMed  Google Scholar 

  58. Yamada T, Komiya I, Miyahara Y, et al. Effect of methimazole treatment for 2 years on circulating IL-4, IgE, TBII, and TSAb in patients with hyperthyroid Graves’ disease. Endocr J 2006, 53: 783–8.

    Article  PubMed  Google Scholar 

  59. Kim H, Kim S, Chae J, Kim D, Baek S, Won K, Sung Y. A possible common link between Graves’ disease and allergic immune response. Endocrine Abstracts 15th International & 14th European Congress of Endocrinology (ICE/ECE 2012), vol. 29, P1616.

  60. Amino N, Hidaka Y, Takano T, Izumi Y, Tatsumi KI, Nakata Y. Association of seasonal allergic rhinitis is high in Graves’ disease and low in painless thyroiditis. Thyroid 2003, 13: 811–4.

    Article  PubMed  Google Scholar 

  61. Cooper DS. Antithyroid drugs. N Engl J Med 2005, 3: 905–17.

    Article  Google Scholar 

  62. Betterle C, Zanchetta R. Update on autoimmune polyendocrine syndromes (APS). Acta Biomed Ateneo Parmense 2003, 74: 9–33.

    Google Scholar 

  63. Betterle C, Presotto F. Autoimmune polyendocrine syndromes (APS) or multiple autoimmune syndrome (MAS). In: Walker S, Jara LJ, eds. Handbook of systemic autoimmune diseases. Endocrine manifestations of systemic autoimmune diseases (vol. 9). Amsterdam: Elsevier. 2008, 135–48.

    Chapter  Google Scholar 

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Authors and Affiliations

  1. Unit of Endocrinology, Nuclear Medicine Unit University of Messina, Messina, Italy

    R. M. Ruggeri MD, PhD, S. Cannavò & F. Trimarchi

  2. School and Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, Nuclear Medicine Unit University of Messina, Messina, Italy

    S. Imbesi, S. Saitta & S. Gangemi

  3. Department of Radiological Sciences, Nuclear Medicine Unit University of Messina, Messina, Italy

    A. Campennì

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  1. R. M. Ruggeri MD, PhD
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  2. S. Imbesi
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  3. S. Saitta
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  7. S. Gangemi
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Correspondence to R. M. Ruggeri MD, PhD.

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Ruggeri, R.M., Imbesi, S., Saitta, S. et al. Chronic idiopathic urticaria and Graves’ disease. J Endocrinol Invest 36, 531–536 (2013). https://doi.org/10.3275/8940

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