The Role of Neutrophils in Difficult-to-Treat Chronic Urticaria

Abstract

RationaleNeutrophil predominance may be seen in the skin biopsies of difficult-to-treat chronic urticaria (dCU) patients. Data regarding the clinical course of CU patients based on the tissue infiltrate obtained from skin biopsy is limited. Our study compared serological and clinical parameters between neutrophilic-predominant urticaria (NU) and lymphocytic-predominant urticaria (LU) patients.MethodsFifty-one biopsies from dCU patients from 1999-2011 were reviewed. dCU was defined as treatment failure with at least 2 concurrent anti-histamines, use of oral steroids and/or immunomodulators. All biopsies were reviewed independently by 2 pathologists for cell count. Autoimmune markers (anti-nuclear antibody, anti-thyroid antibodies, rheumatoid factor, CU index), medications given (oral steroids, immunomodulators) and response to treatment were analyzed.ResultsSeventy-five percent (38/51) of patients were neutrophil predominant on biopsy. Forty-nine percent (25/51) had negative autoimmune markers. Sixty-seven percent (34/51) were on oral steroids and 18% (9/51) were on immunomodulators (dapsone, omalizumab, hydroxychloroquine, sulfasalazine). Twenty-seven percent (14/51) had complete resolution of symptoms, while 73% (37/51) had incomplete resolution. There was no statistically significant difference in the presence of autoimmune markers, resolution of symptoms, steroid and immunomodulator use between NU and LU patients.ConclusionsIn our study population, neutrophils were the predominant cell type on biopsy among dCU patients. However, this was not significantly associated with the presence of autoimmune markers or the use of steroids or immunomodulators. Further studies are needed to determine the influence of neutrophils and lymphocytes in dCU and its responsiveness to medical treatment. RationaleNeutrophil predominance may be seen in the skin biopsies of difficult-to-treat chronic urticaria (dCU) patients. Data regarding the clinical course of CU patients based on the tissue infiltrate obtained from skin biopsy is limited. Our study compared serological and clinical parameters between neutrophilic-predominant urticaria (NU) and lymphocytic-predominant urticaria (LU) patients. Neutrophil predominance may be seen in the skin biopsies of difficult-to-treat chronic urticaria (dCU) patients. Data regarding the clinical course of CU patients based on the tissue infiltrate obtained from skin biopsy is limited. Our study compared serological and clinical parameters between neutrophilic-predominant urticaria (NU) and lymphocytic-predominant urticaria (LU) patients. MethodsFifty-one biopsies from dCU patients from 1999-2011 were reviewed. dCU was defined as treatment failure with at least 2 concurrent anti-histamines, use of oral steroids and/or immunomodulators. All biopsies were reviewed independently by 2 pathologists for cell count. Autoimmune markers (anti-nuclear antibody, anti-thyroid antibodies, rheumatoid factor, CU index), medications given (oral steroids, immunomodulators) and response to treatment were analyzed. Fifty-one biopsies from dCU patients from 1999-2011 were reviewed. dCU was defined as treatment failure with at least 2 concurrent anti-histamines, use of oral steroids and/or immunomodulators. All biopsies were reviewed independently by 2 pathologists for cell count. Autoimmune markers (anti-nuclear antibody, anti-thyroid antibodies, rheumatoid factor, CU index), medications given (oral steroids, immunomodulators) and response to treatment were analyzed. ResultsSeventy-five percent (38/51) of patients were neutrophil predominant on biopsy. Forty-nine percent (25/51) had negative autoimmune markers. Sixty-seven percent (34/51) were on oral steroids and 18% (9/51) were on immunomodulators (dapsone, omalizumab, hydroxychloroquine, sulfasalazine). Twenty-seven percent (14/51) had complete resolution of symptoms, while 73% (37/51) had incomplete resolution. There was no statistically significant difference in the presence of autoimmune markers, resolution of symptoms, steroid and immunomodulator use between NU and LU patients. Seventy-five percent (38/51) of patients were neutrophil predominant on biopsy. Forty-nine percent (25/51) had negative autoimmune markers. Sixty-seven percent (34/51) were on oral steroids and 18% (9/51) were on immunomodulators (dapsone, omalizumab, hydroxychloroquine, sulfasalazine). Twenty-seven percent (14/51) had complete resolution of symptoms, while 73% (37/51) had incomplete resolution. There was no statistically significant difference in the presence of autoimmune markers, resolution of symptoms, steroid and immunomodulator use between NU and LU patients. ConclusionsIn our study population, neutrophils were the predominant cell type on biopsy among dCU patients. However, this was not significantly associated with the presence of autoimmune markers or the use of steroids or immunomodulators. Further studies are needed to determine the influence of neutrophils and lymphocytes in dCU and its responsiveness to medical treatment. In our study population, neutrophils were the predominant cell type on biopsy among dCU patients. However, this was not significantly associated with the presence of autoimmune markers or the use of steroids or immunomodulators. Further studies are needed to determine the influence of neutrophils and lymphocytes in dCU and its responsiveness to medical treatment.