Abstract
BackgroundThe pathogenesis of chronic spontaneous urticaria (CSU) is still insufficiently understood. Recent findings suggest that immunoglobulins, in particular IgE but also IgA, play a role in the development of CSU.ObjectiveOur aim was to assess differences in clinical and laboratory markers between CSU patients with and without lower levels of serum IgA and IgE.MethodsWe analyzed the data of 606 patients with CSU by dividing them into four groups based on their IgA and IgE levels. The groups were compared for their spectrum of symptoms, disease activity, concomitant autoimmunity and routine laboratory markers. Autoreactivity was assessed by basophil activation test (BAT). Moreover, IgE-anti-thyroid peroxidase (TPO) was measured.ResultsOf the patients with lower IgE levels, 66.5% also had lower IgA levels (r=0.316, p<0.001). Patients with lower IgA and lower IgE levels showed a higher prevalence of recurrent angioedema (p=0.03, p=0.04) and concomitant autoimmunity (p=0.006, p<0.001). Autoreactivity was also found more frequently in patients with lower IgA and lower IgE levels (p=0.003, p<0.001). Reduced basophil counts were linked to both, lower IgA and lower IgE levels (p<0.001), whereas low eosinophil counts were primarily present in patients with lower IgE levels (p=0.04, p<0.001). Patients with elevated IgE-anti-TPO levels had lower IgA (p=0.007) and IgE levels (p=0.001).ConclusionLower IgA levels in CSU are linked to lower IgE levels and features of autoimmune urticaria. Our findings encourage to screen CSU patients for serum IgA and IgE levels and to further assess their role as disease biomarkers.
Highlights
Chronic spontaneous urticaria (CSU) is a common disease that affects around 1% of the general population [1]
Type IIb autoimmunity is characterized by mast cell-activating immunoglobulin G (IgG)-antibodies, for example against immunoglobulin E (IgE) [8] or its high-affinity receptor FcεRI [9], that induce histamine release of mast cells and basophils
Patients with type IIb autoimmunity are characterized by a positive autologous serum skin test (ASST), serum autoreactivity in basophil activation test (BAT) or basophil histamine release assay (BHRA) and a positive immunoassay for IgG-antibodies against FcεRI or IgE [10]
Summary
Chronic spontaneous urticaria (CSU) is a common disease that affects around 1% of the general population [1]. It is characterized by the appearance of pruritic wheals, angioedema or both for more than six weeks without a specific and definite triggering factor [2]. Type IIb autoimmunity is characterized by mast cell-activating IgG-antibodies, for example against IgE [8] or its high-affinity receptor FcεRI [9], that induce histamine release of mast cells and basophils. Patients with type IIb autoimmunity are characterized by a positive autologous serum skin test (ASST), serum autoreactivity in basophil activation test (BAT) or basophil histamine release assay (BHRA) and a positive immunoassay for IgG-antibodies against FcεRI or IgE [10]. Recent findings suggest that immunoglobulins, in particular IgE and IgA, play a role in the development of CSU
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