Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: A systematic review

Abstract

Patients with chronic spontaneous urticaria (CSU) are widely held to often have other autoimmune disorders, including autoimmune thyroid disease. Here, we systematically evaluated the literature on the prevalence of thyroid autoimmunity in CSU and vice versa. There is a strong link between CSU and elevated levels of IgG antithyroid autoantibodies (AAbs), with most of a large number of studies reporting rates of ≥10%. Levels of IgG against thyroid peroxidase (TPO) are more often elevated in CSU than those of other IgG antithyroid AAbs (strong evidence). Levels of IgG antithyroid AAbs are more often elevated in adult patients with CSU than in children (strong evidence). Patients with CSU exhibit significantly higher levels of IgG antithyroid AAbs (strong evidence) and IgE-anti-TPO (weak evidence) than controls. Elevated IgG antithyroid AAbs in CSU are linked to the use of glucocorticoids (weak evidence) but not to disease duration or severity/activity, gender, age, or ASST response (inconsistent evidence). Thyroid dysfunction rates are increased in patients with CSU (strong evidence). Hypothyroidism and Hashimoto's thyroiditis are more common than hyperthyroidism and Graves' disease (strong evidence). Thyroid dysfunction is more common in adult patients with CSU than in children (strong evidence) and in female than in male patients with CSU (weak evidence). Urticaria including CSU is more prevalent in patients with thyroid autoimmunity than in controls (weak evidence). CSU can improve in response to treatment with levothyroxine or other thyroid drugs (strong evidence). Pathogenic mechanisms in CSU patients with thyroid autoimmunity may include IgE against autoantigens, immune complexes, and complement.

The role and relevance of mast cells in urticaria

“…Thus, an autoallergy is postulated in which IgE is directed to an element of self . This is supported by studies that have shown that patients with CSU have high levels of IgE autoantibodies such as IgE‐anti‐TPO and IgE‐anti‐dsDNA in their blood . More recently, using array analyses, over 200 IgE‐autoantigens were found in CSU patients that were not present in controls.…”

“…Studies showing the presence of IgG‐anti‐IgE and IgG‐anti‐FcεRI antibodies are summarized in Table . The evidence in support of this mechanism of CSU has been reviewed recently . Removal of IgE and subsequent loss of mast cell FcεRI would explain the slow onset of action of omalizumab seen in up to 30% of patients responding to omalizumab .…”

Biomarkers and clinical characteristics of autoimmune chronic spontaneous urticaria: Results of the PURIST Study

“…Subsequent studies showed that IgG antibodies to the patient's own IgE or its high‐affinity receptor (FcεRI) were instrumental in causing basophil and mast cell degranulation in vitro and are believed to be directly relevant to urticaria pathogenesis . This response has been reviewed in detail recently …”

¿Es posible simplificar el abordaje diagnóstico de urticaria crónica? Una lista de verificación de información clínica

“…Condiciones sistémicas mediadas por el complemento (crioglobulinemia, enfermedad del suero), enfermedades del tejido conectivo (lupus eritematoso sistémico), neoplasias (trastornos linfoproliferativos), trastornos endocrinos o terapias hormonales (tumores ováricos y uso de anticonceptivos orales, respectivamente) y autoanticuerpos antitiroideos 13,14 se han correlacionado con UCE. En UCInd hay un grupo heterogéneo de estímulos que incluyen la causa colinérgica y las físicas como frío y calor, presión retardada, dermografismo, sol, agua y vibración.…”