Prevalence and relevance of skin autoreactivity in chronic urticaria

Abstract

Autoreactive urticaria, a subgroup of chronic spontaneous urticaria, is caused by circulating mast cell-activating serum factors. Skin autoreactivity can be identified by a wheal-and-flare reaction following the injection of autologous serum into the skin. This autologous serum skin test also functions as a screening tool for functional mast cell-activating autoantibodies against IgE or its high affinity receptor FceRI consistent with autoimmune urticaria. To confirm the presence and relevance of these autoantibodies in autologous serum skin test-positive patients, western blot/ELISA and cell activation assays are required. This review focuses on the prevalence and relevance of skin autoreactivity in chronic spontaneous urticaria. It describes diagnostic procedures and treatment options and gives an outlook on how to improve the management of autoreactive urticaria.