Autoimmune urticaria

Autoimmune urticaria
A medical illustration depicting urticaria on the palm, wrist and forearm
SpecialtyImmunology, dermatology
SymptomsHives, pruritus
MedicationAntihistamines, omalizumab
Frequency0.23% (US)[1]

Autoimmune urticaria, also known as chronic autoimmune urticaria, is a type of chronic urticaria characterized by the presence of autoantibodies in the patient's immune system that target the body's own mast cells, leading to episodes of hives (urticaria).[2][3] This immunologically distinct type of urticaria is considered autoimmune because the immune system, which normally protects the body from foreign organisms, mistakenly attacks the body's own cells, causing inflammation and other symptoms.[4]

The condition is chronic, meaning it persists for more than six weeks, and can last for many years.[5] Symptoms include recurrent episodes of hives, which are red, itchy, and swollen areas on the skin. These episodes can be triggered by various factors, including heat, stress, or for no identifiable reason.[6]

Autoimmune urticaria is a relatively rare condition, affecting a small percentage of the population.[1] However, it can significantly impact the quality of life of those affected due to the unpredictability and discomfort of the symptoms.[7] The exact cause of autoimmune urticaria is not fully understood, but it is believed to involve a complex interplay of genetic and environmental factors.[8]

Diagnosis is typically based on the clinical history and physical examination, and confirmed by laboratory tests.[9][10] Treatment primarily involves managing symptoms and includes the use of antihistamines, corticosteroids, monoclonal antibodies (omalizumab), and in some cases, immunosuppressive drugs.[11][12]

Despite ongoing research, many aspects of autoimmune urticaria remain poorly understood, and it continues to be a challenging condition to manage. The economic burden is significant, with costs as high as $2050 per year per patient in the United States.[13]

  1. ^ a b Wertenteil, Sara; Strunk, Andrew; Garg, Amit (2019). "Prevalence estimates for chronic urticaria in the United States: A sex- and age-adjusted population analysis". Journal of the American Academy of Dermatology. 81 (1). Elsevier BV: 152–156. doi:10.1016/j.jaad.2019.02.064. ISSN 0190-9622. PMID 30872154. S2CID 78092096.
  2. ^ Schoepke, Nicole; Asero, Riccardo; Ellrich, André; Ferrer, Marta; Gimenez-Arnau, Ana; E. H. Grattan, Clive; Jakob, Thilo; Konstantinou, George N.; Raap, Ulrike; Skov, Per Stahl; Staubach, Petra; Kromminga, Arno; Zhang, Ke; Bindslev-Jensen, Carsten; Daschner, Alvaro; Kinaciyan, Tamar; Knol, Edward F.; Makris, Michael; Marrouche, Nadine; Schmid-Grendelmeier, Peter; Sussman, Gordon; Toubi, Elias; Church, Martin K.; Maurer, Marcus (2019-07-29). "Biomarkers and clinical characteristics of autoimmune chronic spontaneous urticaria: Results of the PURIST Study" (PDF). Allergy. 74 (12). Wiley: 2427–2436. doi:10.1111/all.13949. ISSN 0105-4538. PMID 31228881. S2CID 195298843.
  3. ^ Goh, CL; Tan, KT (2009). "Chronic autoimmune urticaria : Where we stand?". Indian Journal of Dermatology. 54 (3). Medknow: 269–274. doi:10.4103/0019-5154.55640. ISSN 0019-5154. PMC 2810697. PMID 20161862.
  4. ^ "Autoimmune Diseases". NIH: National Institute of Allergy and Infectious Diseases. 2022-10-06. Retrieved 2023-06-25.
  5. ^ Dionigi, P.C.L.; Menezes, M.C.S.; Forte, W.C.N. (2016). "A prospective ten-year follow-up of patients with chronic urticaria". Allergologia et Immunopathologia. 44 (4). Codon Publications: 286–291. doi:10.1016/j.aller.2015.10.004. ISSN 0301-0546. PMID 27083494.
  6. ^ "Symptoms and causes". Mayo Clinic. 2023-04-25. Retrieved 2023-06-25.
  7. ^ O'DONNELL, B.F.; LAWLOR, F.; SIMPSON, J.; MORGAN, M.; GREAVES, M.W. (1997). "The impact of chronic urticaria on the quality of life". British Journal of Dermatology. 136 (2). Oxford University Press (OUP): 197–201. doi:10.1046/j.1365-2133.1997.d01-1168.x. ISSN 0007-0963. PMID 9068731. S2CID 19855822.
  8. ^ Bansal, Ciara Jade; Bansal, Amolak Singh (2019-09-11). "Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria". Allergy, Asthma & Clinical Immunology. 15 (1). Springer Science and Business Media LLC: 56. doi:10.1186/s13223-019-0372-z. ISSN 1710-1492. PMC 6737621. PMID 31528163.
  9. ^ Grattan, C.E.H.; Boon, A.P.; Eady, R.A.J.; Winkelmann, R.K. (1990). "The Pathology of the Autologous Serum Skin Test Response in Chronic Urticaria Resembles IgE-Mediated Late-Phase Reactions". International Archives of Allergy and Immunology. 93 (2–3). S. Karger AG: 198–204. doi:10.1159/000235301. ISSN 1018-2438. PMID 2099345.
  10. ^ Kikuchi, Yoko; Kaplan, Allen P. (2001). "Mechanisms of autoimmune activation of basophils in chronic urticaria". Journal of Allergy and Clinical Immunology. 107 (6). Elsevier BV: 1056–1062. doi:10.1067/mai.2001.115484. ISSN 0091-6749. PMID 11398085.
  11. ^ Kocatürk, Emek; Can, Pelin Kuteyla; Akbas, Pırıl Etikan; Copur, Mehmet; Degirmentepe, Ece Nur; Kızıltac, Kübra; Singer, Ralfi (2017). "Management of chronic inducible urticaria according to the guidelines: A prospective controlled study". Journal of Dermatological Science. 87 (1). Elsevier BV: 60–69. doi:10.1016/j.jdermsci.2017.02.283. ISSN 0923-1811. PMID 28314658.
  12. ^ Kanani, Amin; Schellenberg, Robert; Warrington, Richard (2011-11-10). "Urticaria and angioedema". Allergy, Asthma & Clinical Immunology. 7 (S1). Springer Science and Business Media LLC: S9. doi:10.1186/1710-1492-7-s1-s9. ISSN 1710-1492. PMC 3245442. PMID 22165855.
  13. ^ DeLong, Laura K.; Culler, Steven D.; Saini, Sarbjit S.; Beck, Lisa A.; Chen, Suephy C. (2008-01-01). "Annual Direct and Indirect Health Care Costs of Chronic Idiopathic Urticaria". Archives of Dermatology. 144 (1). American Medical Association (AMA): 35–39. doi:10.1001/archdermatol.2007.5. ISSN 0003-987X. PMID 18209166.