Article

Classification of anti-FcepsilonRI and anti-IgE autoantibodies in chronic idiopathic urticaria and correlation with disease severity.

St John's Institute of Dermatology and the Department of Obstetrics and Gynaecology, Guy's, King's and St Thomas' School of Medicine, King's College London, St Thomas' Hospital, London.
Journal of Allergy and Clinical Immunology (Impact Factor: 11.25). 10/2002; 110(3):492-9.
Source: PubMed

ABSTRACT Circulating autoantibodies against FcepsilonRI, IgE, or both occur in approximately one third of patients with chronic idiopathic urticaria (CIU), but not all autoantibodies initiate histamine release.
We sought to classify patients with CIU into subsets on the basis of serum bioactivity and immunoreactivity and to examine the relationship between newly defined subtype and disease severity.
Sera from patients with CIU (n = 78), dermog-raphism (n = 15), and cholinergic urticaria (n = 10) and sera from healthy subjects (n = 39) were analyzed by means of Western blot analysis for anti-FcepsilonRI autoantibodies and for histamine release from basophils and dermal mast cells. In vivo reactivity of autologous serum was tested by means of intradermal injection, and CIU severity was determined on the basis of clinical interview.
We classified sera from patients with CIU into 5 subsets: immunoreactive histamine-releasing anti-FcepsilonRI autoantibodies (n = 20 [26%]); immunoreactive anti-FcepsilonRI autoantibodies without histamine-releasing activity (n = 12 [15%]); anti-IgE-like autoantibodies (n = 7 [9%]); serum containing a mast cell-specific histamine-releasing factor (n = 7 [9%]); and sera with no identifiable factor (n = 32 [41%]). Patients with serum histamine-releasing activity had more severe urticaria than patients without such activity. Positive skin test responses to autologous sera were associated with histamine-releasing anti-FcepsilonRI autoantibodies but not with non-histamine-releasing anti-FcepsilonRI autoantibodies. Neither healthy subjects nor patients with dermographism or cholinergic urticaria had his-tamine-releasing anti-FcepsilonRI autoantibodies.
These data support the specificity of functional anti-FcepsilonRI autoantibodies to CIU. The identification of distinctive subsets of patients suggests that other pathogenic mechanisms occur in CIU in addition to direct ligation of FcepsilonRI by autoantibodies causing dermal mast cell degranulation. Elucidating these mechanisms might lead to new treatments for CIU.

Download full-text

Full-text

Available from: Paul T Seed, Jul 28, 2015
0 Followers
 · 
209 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Alerjinin Bilinmez Sorununa Tanısal Yaklaşım: Kronik Ürtiker ve Anjioödem Altı haftadan uzun süren ürtiker olarak tanımlanan kronik ürtikerin nedeni çoğunlukla bulunamamaktadır. Kronik ürtikerli vakaların yarısına anjioödem de eşlik eder. Tanı temel olarak hastanın anamnezine dayanmaktadır. Kronik otoimmün ürtikerli çocukların % 30-40'ında IgE ya da IgE reseptörüne karşı fonksiyonel otoantikorlar saptanmakta-dır. Otolog serum deri testi kronik otoimmün ürtiker için yapılması gereken bir tarama testidir. Anahtar kelimeler: Kronik ürtiker, anjioödem, çocuk Çocuk Dergisi 2009; 9(2):68-75 Unknown Problem of Allergy: Chronic Urticaria and Angioedema The etiology of chronic urticaria (CU), defined as recur-ring attacks of hives lasting for 6 weeks, often remains unrecognized. Half of patients with chronic urticaria have also angioedema. The diagnosis is based principally on the patient's history. It has been shown that approximately 30 %-40 % of children with CU produce functionally acti-ve autoantibodies directed against IgE or IgE receptor defined as chronic autoimmune urticaria (COU). Autologous serum skin test possibly should be performed in children as a screening test for idiopathic autoimmune CU.
  • Journal of Clinical Gastroenterology 01/2003; 36(5):454-5. DOI:10.1097/00004836-200305000-00023 · 3.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic idiopathic urticaria has long been a demoralizing disease, baffling allergists and dermatologists alike, to the detriment of the patient. Recent findings, however, have shed light on causation in many, though not all, of these patients. The purpose of this review is to bring the reader up to date on the current position regarding aetiology and pathogenesis and the strength of the evidence. The review also seeks to point up rational approaches to diagnosis and treatment in the light of these developments. Chronic idiopathic urticaria encompasses at least two subgroups. One of these is the now well-established entity of autoimmune chronic urticaria, due to autoantibodies against either the high-affinity IgE receptor Fc epsilon R1 or, less commonly, IgE. These patients, who co-segregate with chronic idiopathic urticaria patients having an increased frequency of antithyroid autoantibodies, represent 30-50% of the patients previously designated as having chronic idiopathic urticaria. Convenient routine diagnostic tests for this subset remain elusive. The remaining 50% of patients with chronic idiopathic urticaria remain truly 'idiopathic', although the condition in some may have an autoimmune basis, autoantibodies having eluded current techniques for detection. Selected patients with autoimmune urticaria may benefit from immunotherapy. It is now known that in 30-50% of patients with chronic idiopathic urticaria, the condition has an autoimmune basis, although confirmation of the diagnosis in these patients is not straightforward. In selected patients, attempts to establish this diagnosis are worthwhile since there are important therapeutic implications.
    Current Opinion in Allergy and Clinical Immunology 11/2003; 3(5):363-8. DOI:10.1097/01.all.0000092607.76804.f1 · 3.66 Impact Factor
Show more