Thyroid Autoimmunity and Autoimmunity in Chronic Spontaneous Urticaria Linked to Disease Severity, Therapeutic Response, and Time to Remission in Patients with Chronic Spontaneous Urticaria

Abstract

Background Chronic spontaneous urticaria (CSU) is autoimmune in nature and associated with thyroid autoimmunity (TA), but evidence on autoimmunity in relation to CSU progression and prognosis is limited. We evaluated whether TA and autoimmunity in CSU are correlated with disease severity, therapeutic response, and time to remission and establish an association between CSU characteristics linked to thyroid autoantibody. Methods Medical records of patients diagnosed with urticaria attending outpatient dermatology clinic at a university-based hospital from 2013 to 2017 were retrospectively reviewed. Data on the clinical characteristics, laboratory investigations particularly thyroid antibody titers, autologous serum skin test (ASST) and autologous plasma skin test (APST) results and their link to disease severity, treatments, and time to remission of CSU patients were analyzed. Results Of 1,096 patients with urticaria, 60.2% had CSU. Three-hundred patients fulfilled the inclusion criteria for CSU with complete thyroid antibody testing. Positive TA was significantly associated with female gender and age > 35 years (p = 0.008). Antithyroid peroxidase (anti-TPO)-positive patients suffered from CSU longer than 12 and 18 months compared to anti-TPO-negative patients (100.0% vs. 82.6%, p = 0.042, and 100.0% vs. 75.9% p = 0.020, respectively). The presence of urticarial attacks > 4 days/week was significantly seen in ASST and APST-positive patients compared to those without (84.6% vs. 61.3%, p = 0.011, and 85.3% vs. 61.8%, p = 0.006, respectively). Positive APST patients were more difficult to treat than those with negative results (61.2% vs. 37.8%, p = 0.017). Conclusions Antithyroid peroxidase is a predictor of time to remission, while autologous skin testing is linked to disease severity (ASST and APST) and therapeutic response (APST) in CSU patients.

Correlations between disease activity, autoimmunity and biological parameters in patients with chronic spontaneous urticaria

“…(8, 20) Presence of concomitant autoimmune disease and/orAAbs or positivity of ASST was not correlated with disease activity nor with H1-antihistamines response. In the literature, this association between ASST and disease activity remains controversial (16,(20)(21)(22). In line with previous reports, angioedema was more frequent in patients with positive ASST in our cohort (17,18).…”

<p>Biomarkers In Chronic Spontaneous Urticaria: Current Targets And Clinical Implications</p>

“…It is well known that mast cells are the main effector cells in the pathogenesis of urticaria trough the release of their pre-formed and newly synthesized mediators 2,6. Although the triggers of mast cells activation in CSU are largely unknown and remain to be identified, several studies have allowed to identify in subgroups of CSU patients IgG autoantibodies directed to thyroid peroxidase (TPO) and/or to IgE or to their high-affinity IgE receptor (FcεRI) 7,8. Evidences of the role of autoimmunity in CSU stems from the observation that patients with CSU often have autoimmune disorders, including autoimmune thyroid disease 9.…”

The effect of at least 1‐year use of omalizumab without interruption on relapse in patients with chronic spontaneous urticaria

“…Multiple factors may be involved in the clinical and prognostic polymorphism of CSU. [3][4][5] The guidelines for the treatment of CSU recommend the use of second-generation nonsedating H1-antihistamines for initial therapy and suggest up-dosing of these antihistamines up to 4-fold in patients with CSU who are unresponsive to standard doses. When they fail to achieve success, the guidelines recommend the use of omalizumab (OMA) as third-line therapy.…”