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Pathophysiology of chronic urticaria

Greaves MW

Int Arch Allergy Immunol, 2002 Jan;127(1):3-9.
PMID: 11893848 DOI: 10.1159/000048163

Chronic urticaria includes several different subsets with distinct pathophysiologies, and with important implications for investigation and treatment. Chronic 'idiopathic' urticaria represents a special challenge, which, until recently, was not taken up by dermatological or immunological investigators. However, it has now emerged that at least 30% of patients possess histamine-releasing autoantibodies against Fc epsilon R1, or less commonly IgE itself. These autoantibodies are causative. Recent work implicates complement activation in most cases. Functional (i.e. histamine releasing) autoantibodies are specific to chronic urticaria. However, immunoreactive (non-histamine-releasing) anti-Fc epsilon R1 autoantibodies can be found in sera of patients with physical urticarias and with autoimmune connective tissue and bullous diseases. The reason for the occurrence of this disease type in some individuals but not others is unclear. One possibility is the development, in genetically predisposed persons, of autoantibodies by molecular mimicry - perhaps against lipopolysaccharide of Helicobacter pylori, an organism frequently infecting the upper gastrointestinal tract of chronic urticaria patients.

Matched MeSH terms: Urticaria/etiology
Wearing test with 2 different types of latex gloves with and without the use of a skin protection cream

Allmers H

Contact Derm., 2001 Jan;44(1):30-3.
PMID: 11156008

72 subjects reporting symptoms indicating Type I hypersensitivity reactions to natural rubber latex (NRL) gloves were included in this study. 44 of them had a positive prick test to NRL. They underwent wearing tests using 2 types of NRL gloves with high (n=63) and low (n=70) allergen contents. Unigloves Malaysia with a high allergen content caused positive skin reactions in 47% of SPT-positive and no IgE-negative subjects. After application of Hand Sense skin protection cream, the frequency of positive skin responses in wearing tests decreased to 30% in prick-test-positive subjects. The Biogel Diagnostic gloves with low allergen caused hypersensitivity with and without Hand Sense in 2 cases (5%) of the prick-test-positive. 60% of all test participants had a positive prick test to NRL. No prick-test-negative subjects showed any urticaria during the glove-wearing test. Our study demonstrates that high allergen contents in latex gloves frequently elicit skin responses in NRL-sensitized subjects. Since other skin protection creams have shown to increase allergic symptoms, it is encouraging to report that Hand Sense skin cream may hamper the uptake of allergens from gloves, thus decreasing allergic reactions.

Matched MeSH terms: Urticaria/etiology
Treatment of chronic urticaria with thyroxine in an euthyroid patient with thyroglobulin and microsomal antibodies

Koh CK, Hew FL, Chiu CL

Ann Acad Med Singap, 2000 Jul;29(4):528-30.
PMID: 11056786

INTRODUCTION: The association of chronic urticaria and thyroid autoimmunity is not well recognised and the potential use of thyroxine in the treatment of chronic urticaria in patients with thyroid autoimmunity is even less well known.
CLINICAL PICTURE: We report a case of chronic urticaria in an euthyroid patient with evidence of significantly elevated levels of thyroglobulin and microsomal antibodies.
TREATMENT AND OUTCOME: Treatment with thyroxine has brought about clinical remission of the chronic urticaria but no change in the thyroid antibody levels could be demonstrated.
CONCLUSION: Patients with chronic urticaria should be screened for evidence of thyroid autoimmunity. A closely monitored trial of thyroxine therapy for those who have thyroid autoimmunity can be rewarding.

Matched MeSH terms: Urticaria/etiology*
Fulltext A prospective study on the use of leucocyte-filters in reducing blood transfusion reactions in multi-transfused thalassemic children

Tan KK, Lee WS, Liaw LC, Oh A

Singapore Med J, 1993 Apr;34(2):109-11.
PMID: 8266145

Two hundred and eleven blood transfusions were administered to 26 multi-transfused thalassemic children (aged 9 months-13 years) over a 6-month period. Eighteen children were receiving buffy coat-poor packed red cells (PRC) prepared by centrifuge while 8 children received filtered blood through a leucocyte-filter (Sepacell R-500A). Transfusion reactions occurred in 8.5% (n = 18) of transfusions and in 42.3% (n = 11) of patients. 11.9% (n = 16) and 2.6% (n = 2) of reactions occurred in 50% (n = 9) and 25% (n = 2) of patients receiving buffy coat-poor PRC and filtered blood respectively. Transfusion reactions in toto were significantly reduced in the group receiving filtered blood (p < 0.05). However, febrile reaction alone was not significantly reduced (p > 0.1). The median onset and duration of reaction were 2 hours (range 10 minutes-18 hours) and 4 hours (range 1/2-24 hours) respectively. 72.2% (n = 13) of the reactions occurred occurred during transfusion. 88.8% (n = 16) of the reactions caused only one symptom. 19.2% (n = 5) of all patients had recurrent reactions, all of them receiving buffy coat-poor PRC. The commonest clinical manifestation was fever (n = 7), followed by urticaria (n = 5) and petechial rash (n = 2). The outcome was good, with no patient experiencing symptoms exceeding 24 hours. Only 0.9% (n = 2) of the transfusions were discontinued.

Matched MeSH terms: Urticaria/etiology