Clinical utility of testing for autoimmunity in chronic idiopathic urticaria

Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Journal of the American Academy of Dermatology (Impact Factor: 4.45). 05/2011; 66(3):e83-8. DOI: 10.1016/j.jaad.2010.11.030
Source: PubMed


Positive autoimmune testing in patients with chronic idiopathic urticaria (CIU) has previously been associated with more severe disease.
We sought to determine whether patients with CIU and a positive autoimmune urticaria test finding were more difficult to treat clinically.
In this retrospective study, 428 patients seen by physicians of the Department of Dermatology, University of Pittsburgh between January 2007 and March 2010 were identified by International Classification of Diseases, Ninth Revision code 708.9 for urticaria. Included individuals met clinical criteria for CIU and had an autoimmune urticaria test (chronic urticaria index or CD203 expression test) result in their medical record.
Twenty patients met the study criteria set forth and positive autoimmune urticaria test results occurred in 8 of the 20 patients. In all, 75% of patients in each group (positive and negative autoimmune test findings) were more than 75% clear of disease (P = 1) by the last visit. Mean number of distinct medications prescribed for urticaria management in the positive and negative autoimmune groups was 6.9 and 8.4, respectively (P = .4). No significant difference was detected between the various medications that led to more than 75% disease clearance in either group. The mean number of patient clinic visits over the study period was 3.1 and 4.8, respectively, for positive and negative groups (P = .5).
This was a retrospective study with a small sample size.
A positive autoimmune urticaria test finding in the setting of CIU is not indicative of a more complicated clinical course.

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    ABSTRACT: The clinical implications of autoimmune testing in chronic idiopathic urticaria (CIU) are not well established. To identify the association of autoimmune biomarkers in CIU with disease severity. We retrospectively evaluated 195 patients with a diagnosis of CIU for the presence of antinuclear antibody (ANA), anti-thyroglobulin antibody (ATG), anti-thyroperoxidase antibody (ATPO), and Chronic Urticaria (CU) Index. The patients were categorized into controlled and refractory subgroups based on their response to antihistamines with or without a leukotriene receptor antagonist. The percentage of patients with a positive test for ANA (titer>1:160), ATG, ATPO, and CU Index were 29%, 6%, 26%, and 38%, respectively. Among those tested, the percentage of patients categorized as refractory was significantly higher in those with a positive CU index (80% vs 46%; P = .01) or a positive ANA titer (50% vs 30%; P = .04) than those with negative test results; however, a similar relationship was not observed for ATPO or ATG antibodies. Odds ratios of individual or combinations of autoimmune biomarkers in CIU were examined for associations with refractoriness to antihistamines with or without a leukotriene receptor antagonist. The CU Index alone has an odds ratio of 4.5 (P = .005), whereas the combination of ANA, ATG, and ATPO has an odds ratio of 3.1 (P = .01) and ANA alone has an odds ratio of 2.3 (P = .04) for correlating with a refractory outcome. Our data indicate the CU Index independently has the strongest correlation with disease severity followed by the combination of ANA, ATG, and ATPO and the ANA alone.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 05/2012; 108(5):337-341.e1. DOI:10.1016/j.anai.2012.02.018 · 2.60 Impact Factor
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    ABSTRACT: Chronic idiopathic urticaria (CU) has been associated with other autoimmune diseases and basophil-activating autoantibodies to FcεRI or IgE. It is unknown whether patients with systemicautoimmune diseases have a similar prevalence of these autoantibodies. To compare the prevalences of basophil-activating autoantibodies (elevated CU Index) in patients with CU, rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE). Clinical characteristics and laboratory studies were examined for an association with the CU Index. Adult patients, 27 with CU, 27 with RA, and 26 with SLE, and 20 healthy controls were compared on the basis of the CU Index panel, anti-IgE, and antithyroid antibodies. The CU Index values were significantly higher in the CU group when compared with the RA group but not when compared with the SLE group. 33% of CU, 23% of SLE, 3.7% of RA, and 15% of controls had apositive CU Index. Elevated antithyroid antibody levels did not correlate with a positive CU Index in any of the groups. An elevated CU Index in the SLE group was not associated with age, sex, ethnicity, disease severity, or history of atopy. The CU Index values were elevated in patients with CU and SLE. The presence of these autoantibodies did not correlate with disease activity or presence of thyroid antibodies. Functional autoantibodies may not be specific for chronic idiopathic urticaria, and their role in nonurticarial systemic autoimmune diseases requires further investigation.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 01/2013; 110(1):29-33. DOI:10.1016/j.anai.2012.10.020 · 2.60 Impact Factor
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    ABSTRACT: Abbreviations: AUC, area under the curve; BHR, basophil histamine response; FDA, Food and Drug Administration; FcεRI, IgE receptor; IDST, intradermal skin testing; IQR, interquartile range; NAC, nasal allergen challenge
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