Autoimmune Diseases Are Linked to Type IIb Autoimmune Chronic Spontaneous Urticaria

Abstract

Purpose Patients with chronic spontaneous urticaria (CSU) have an increased risk for comorbid autoimmune diseases. In this retrospective multicenter study of CSU patients, we evaluated clinical and laboratory features of CSU associated with a higher risk of comorbid autoimmune diseases. Methods We analyzed records of CSU patients (n = 1,199) for a history or presence of autoimmune diseases. Patients were diagnosed with type IIb autoimmune CSU (aiCSU) if all 3 tests were positive: autologous serum skin test (ASST), basophil histamine release assay (BHRA) and/or basophil activation test (BAT), and IgG autoantibodies against FcεRIα/IgE detected by immunoassay. Results Twenty-eight percent of CSU patients had at least 1 autoimmune disease. The most prevalent autoimmune diseases were Hashimoto's thyroiditis (HT) (≥ 21%) and vitiligo (2%). Two percent of CSU patients had ≥ 2 autoimmune diseases, most frequently HT plus vitiligo. Comorbid autoimmune diseases, in patients with CSU, were associated with female sex, a family history of autoimmune diseases, and higher rates of hypothyroidism and hyperthyroidism ( P < 0.001). Presence of autoimmune diseases was linked to aiCSU ( P = 0.02). The risks of having autoimmune diseases were 1.7, 2.9 and 3.3 times higher for CSU patients with a positive ASST, BHRA and BAT, respectively. In CSU patients, markers for autoimmune diseases, antinuclear antibodies and/or IgG anti-thyroid antibodies were associated with non-response to omalizumab treatment ( P = 0.013). Conclusions In CSU, autoimmune diseases are common and linked to type IIb autoimmune CSU. Our results suggest that physicians assess and monitor all adult patients with CSU for signs and symptoms of common autoimmune diseases, especially HT and vitiligo.

Genome-Wide DNA Methylation Profile in Whole Blood of Patients With Chronic Spontaneous Urticaria

“…According to the study of Altrichter et al, low tIgE may suggest type IIb autoimmune CSU, poor response to treatment with omalizumab, and a better chance to benefit from cyclosporine treatment (37). The study of Kolkhir et al showed that 28% of CSU patients had at least one autoimmune disease and the most prevalent comorbid autoimmune disease was Hashimoto's thyroiditis (21%) (38). In our study, CSU patients with comorbid autoimmune diseases were excluded.…”

Increased serum free IgE levels in patients with chronic spontaneous urticaria (CSU)☆

“… 34 ASST has been suggested to examine autoantibodies including IgG against FcεRIα or against IgE, and adopted as the gold-standard test to define autoimmune status in CSU patients. 9 , 36 , 37 , 38 However, there have been conflicting comments on the relationship between ASST positivity and disease severity. 9 Patients with positive ASST had more severe urticaria, more prolonged duration, and more frequent attacks of urticaria and gastrointestinal symptoms than negative ASST patients.…”

Screening for Autoimmune Comorbidities in Patients With Chronic Spontaneous Urticaria: Which Tests to Whom

“…In the current issue of the Allergy, Asthma and Immunology Research , Kolkhir et al 9 reported that, of 1,199 CSU patients, 28% had autoimmune comorbidities—mostly autoimmune thyroid diseases (25.4%), vitiligo (2.3%) and rheumatoid arthritis (1.0%)—and 2% had more than 2 autoimmune diseases. In patients with CSU, autoimmune comorbidities were found to be associated with age over 40 years, female sex and the presence of family history of autoimmune diseases or angioedema, and higher disease activity.…”

“… 1 10 Kolkhir et al . 9 found that 24% of CSU patients even with normal thyroid-stimulating hormone levels had autoimmune diseases. However, the positivity for IgG anti-TPO is observed in 90% of autoimmune thyroid diseases 11 and plays a role in progressing overt hypothyroidism 12 and in predicting poor response to omalizumab treatment in CSU patients.…”

“…However, the positivity for IgG anti-TPO is observed in 90% of autoimmune thyroid diseases 11 and plays a role in progressing overt hypothyroidism 12 and in predicting poor response to omalizumab treatment in CSU patients. 9 Therefore, they suggest that all adult CSU patients should be checked for IgG anti-TPO and symptoms of autoimmune diseases at the initial diagnostic workup. In patients positive for IgG anti-TPO, they recommend tests for thyroid function and autoimmune CSU.…”