Urticaria and vasculitis: a continuum of histological and immunopathological changes

Abstract

Histopathological criteria were used to classify twenty-four patients with chronic urticaria into three groups, which were then studied to establish whether circulating immune complexes (CICs), complement activation and deposition of immunoreactants are confined to patients with urticarial vasculitis. Group I (three patients) had classical urticarial vasculitis, and two of these patients showed hypocomplementaemia with evidence of C3 conversion and deposition of immunoreactants in lesional and uninvolved skin. Ten patients (group 2) with a dense perivascular mixed-cellular infiltrate had normal or raised complement levels and infrequent evidence of C3 conversion. Immunoreactants were detected only in their lesional skin. Eleven patients (group 3) had only a sparse perivascular infiltrate. In this group, complement was normal and immunofluorescence was essentially negative. Cryoglobulins were detected in group I patients only. Monoclonal rheumatoid factor and C1q binding were positive in all group I patients, half the group 2 patients and none of the group 3 patients. This study suggests that urticaria and urticarial vasculitis form a disease continuum, and identifies a group of patients with features intermediate between urticarial vasculitis and ordinary urticaria.

Pathogenetic Studies in Chronic Urticaria

“…Moreover, direct IF failed to show deposits of immunoglobulin, com plement or fibrin. These results are in con trast with those of Monroe et al [1] and Rus sel Jones et al [23]. This discrepancy is probably due to a differnce in patient selec tion; in contrast with our series, many of the patients of these authors had associated symptoms pointing to urticarial vasculitis.…”

Pathology of the Cutaneous Vasculitides: A Comprehensive Review

“…The minimal criteria required for diagnosis of UV are leukocytoclasia or fibrin deposits with or without extravasated red blood cells, features which can be subtle and overlap with the histologic findings seen in cutaneous leukocytoclastic angiitis (Black, 1999). There is a wide spectrum of histologic findings in UV, ranging from sparse neutrophilic infiltrate of small vessels to more severe lesions with a dense neutrophilic vasculitis, leukocytoclasia, extravasated red blood cells, endothelial cell swelling and fibrin deposits (Jones et al, 1983). The superficial and mid-dermal vessels are most commonly affected, however, vascular destruction can extend into the deep dermal and pannicular vessels (Davis et al, 1998;Mehregan et al, 1992).…”

The Gut in Skin Disease: Gastro-Intestinal Manifestations of Selected Skin Disorders

“…4). The syndrome is variably asso ciated with hypocomplcmentaemia, circulat ing immune complexes and leukocytoclastic vasculitis in dermal capillaries [32], Thera peutic failure of pharmacological receptor antagonism suggests histamine is not in volved and corticosteroids and other immu nosuppressant drugs are also ineffective al though indomethacin may be of value. Sys temic lupus erythematosus and hepatitis B may have similar presentations, and familial Mediterranean fever (with febrile attacks of peritonitis and synovitis with urticarial or vasculitic skin lesions) should also be consid ered.…”