IgE Mediated Autoallergy against Thyroid Peroxidase – A Novel Pathomechanism of Chronic Spontaneous Urticaria?

Background and aim. Chronic spontaneous urticaria (CSU) is a disease of unknown etiology and autoimmunity has been thought to be an etiological factor. Immunoglobulin E (IgE)-anti-thyroid peroxidase antibodies (anti-TPO) may play a role in the pathogenesis of certain cases of urticaria. The aim of this study is to investigate IgE-anti-TPO in patients with chronic spontaneous urticaria and in patients with Hashimoto’s thyroiditis. Methods. A total of 175 -subjects were included in this study. 59 patients had chronic spontaneous urticaria without history of Hashimoto’s thyroiditis, while 58 patients had Hashimoto’s thyroiditis without history of urticaria. The control group consisted of 58 participants without history of Hashimoto’s thyroiditis and urticaria. Serum IgE-anti-TPO levels were analyzed by site-directed IgE capture Enzyme-Linked Immunosorbent Assay technique. We used this technique by modifying it. Results. IgE-anti-TPO antibodies were detected in all three groups and in all subjects. There was no significant difference between the three groups in terms of IgE-anti-TPO levels. Although total IgE and IgE-anti-TPO levels were higher in the IgG-anti-TPO positive chronic spontaneous urticaria, there was no significant difference. Conclusions. IgE-anti-TPO antibodies do not play a pathogenic role in the majority of patients with chronic spontaneous urticaria.

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Clinical Characterization of Patients with Chronic Spontaneous Urticaria according to Anti-TPO IgE Levels

Journal of Immunology Research ◽

10.1155/2019/4202145 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Jorge Sánchez ◽

Andres Sánchez ◽

Ricardo Cardona

Keyword(s):

Clinical Characteristics ◽

Control Period ◽

Challenge Test ◽

Chronic Spontaneous Urticaria ◽

Thyroid Peroxidase ◽

Test Results ◽

Clinical Control ◽

Inducible Urticaria ◽

Challenge Tests ◽

Urticaria Activity Score

Background. Chronic spontaneous urticaria (CSU) is a heterogeneous disease with some frequent comorbidities like autoimmune diseases, drug reactions, and inducible urticaria. IgE antibodies against thyroid peroxidase (anti-TPO IgE) could be associated with some of these clinical characteristics. Objective. To explore the clinical characteristics of CSU patients, according to the presence of anti-TPO IgE in serum. Methods. Anti-TPO IgE levels were measured during the clinical control period (Urticaria Activity Score, 0 point) and exacerbation period (≥3 points) in 100 CSU patients. Patients with self-reported exacerbation of skin involvement by foods, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical triggers underwent controlled challenge tests. Results. We identified 2 groups of patients: (1) patients with anti-TPO IgE during the clinical control period or during an exacerbation, who had a higher frequency of atopy, asthma, and positive challenge test results with NSAIDs and (2) patients without anti-TPO IgE during any period, who had a higher frequency of positive challenge test results for inducible urticaria. Among the first group (anti-TPO IgE at any point), we identified 3 subgroups: patients with anti-TPO IgE during the clinical control period (n=12); patients with anti-TPO IgE during the clinical control period and significantly increased levels during an urticaria exacerbation (n=18); and patients with anti-TPO IgE only during an exacerbation (n=13). None of the patients with self-reported food reactions had a positive challenge test result. Conclusion. Anti-TPO IgE is a useful biomarker for differentiating between clinical phenotypes of patients with CSU. Elevation of anti-TPO IgE during exacerbation periods supports an association between this autoantibody and the pathogenesis of urticaria.

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Serum Human β-Defensin 2 Is Increased in Angioedema Accompanying Chronic Spontaneous Urticaria

International Archives of Allergy and Immunology ◽

10.1159/000516952 ◽

2021 ◽

pp. 1-6

Author(s):

Thi Bich Tra Cao ◽

Hyun-Young Cha ◽

Eun-Mi Yang ◽

Bo-Youn Choi ◽

Hae-Sim Park ◽

...

Keyword(s):

Mast Cell ◽

Mast Cell Degranulation ◽

Chronic Spontaneous Urticaria ◽

Autologous Serum ◽

Healthy Controls ◽

Serum Samples ◽

Autologous Serum Skin Test ◽

Vitamin D Levels ◽

Ige Mediated ◽

Urticaria Activity Score

Introduction: Chronic spontaneous urticaria (CSU) is a common cutaneous disease caused by mast-cell degranulation. Human β-defensin 2 (HBD2) is a well-known antimicrobial peptide that is also a pruritogen inducing vascular permeability via non-IgE-mediated mast-cell degranulation. Objective: We investigated the associations between serum HBD2 levels and the clinical characteristics of CSU patients. Methods: Serum samples from 124 CSU patients and 56 healthy controls were screened for the levels of HBD2 and translationally controlled tumor protein (TCTP)_ by using ELISA. The urticaria activity score over 7 days (UAS7) was used to measure disease activity in CSU patients. Accompanying angioedema was self-reported. Results: Serum HBD2 levels were higher in the CSU group than in healthy subjects (median [interquartile range], 84.1 [43.5, 142.5] vs. 59.5 [26.7, 121.5], p = 0.034). In CSU patients, serum HBD2 level was negatively correlated with the peripheral basophil percentages (Spearman’s rho = −0.229, p = 0.01) and vitamin D levels (−0.262, p = 0.02), but positively correlated with TCTP levels (0.252, p = 0.006). In CSU patients, HBD2 level was higher in those with than without angioedema (101.7 [50.9, 184.2] vs. 66.7 [37.9, 132.0], p = 0.019). It did not differ by aspirin hypersensitivity or atopy status, or autologous serum skin test positivity. Conclusion: A known mast-cell degranulator, HBD2 was elevated in the sera from CSU patients compared to healthy controls and may be involved in the pathogenesis of accompanying angioedema.

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Lower IgA Levels in Chronic Spontaneous Urticaria Are Associated With Lower IgE Levels and Autoimmunity

Frontiers in Immunology ◽

10.3389/fimmu.2021.657211 ◽

2021 ◽

Vol 12 ◽

Author(s):

Merle Sauer ◽

Jörg Scheffel ◽

Stefan Frischbutter ◽

Pavel Kolkhir ◽

Yi-Kui Xiang ◽

...

Keyword(s):

Disease Activity ◽

Basophil Activation Test ◽

Chronic Spontaneous Urticaria ◽

Thyroid Peroxidase ◽

Routine Laboratory ◽

Disease Biomarkers ◽

Laboratory Markers ◽

Serum Iga ◽

Autoimmune Urticaria ◽

Eosinophil Counts

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.

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Association between chronic spontaneous urticaria and thyroid autoimmunity: a case control study from a tertiary care centre

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20170362 ◽

2017 ◽

Vol 3 (1) ◽

pp. 64 ◽

Cited By ~ 1

Author(s):

Olasseri K. Reena Mariyath ◽

Manikoth P. Binitha ◽

Vadakke P. Anilakumari ◽

George Biju ◽

Pappinisseri K. Nikhila ◽

...

Keyword(s):

Skin Test ◽

Thyroid Function ◽

Antibody Level ◽

Thyroid Autoimmunity ◽

Chronic Spontaneous Urticaria ◽

Autologous Serum ◽

Thyroid Peroxidase ◽

Thyroid Function Tests ◽

Autologous Serum Skin Test ◽

Antibody Levels

Background: The exact etiology of chronic spontaneous urticaria is unknown in the majority of patients. A subset of chronic spontaneous urticaria can be autoimmune and may be associated with thyroid autoimmunity.Methods: Serum anti thyroid peroxidase (anti-TPO) antibody level and thyroid function tests (TFT) including triiodothyronine (T3), thyroxine (T4) and thyroid stimulating hormone (TSH) levels were estimated in 100patients with chronic spontaneous urticaria and 50 controls. Autologous serum skin test (ASST) was done in 84 chronic urticaria patients and 21 patients with high anti-TPO antibody.Results: High anti-TPO antibodies and abnormal thyroid function were seen in 24 (24%) patients each. High anti-TPO antibody levels were seen in nine (18%) and abnormal TFT in 11 (22%) controls. Abnormal TSH was seen in 22 patients (22%) and 6 (12%) controls. Autologous serum skin test was positive in 53 patients with chronic spontaneous urticaria. It was positive in 16 and negative in five out of 21 patients with high anti-TPO antibody levels. Conclusions: Though there was a slight increase in abnormal anti-TPO antibody level and thyroid dysfunction in patients with chronic spontaneous urticaria compared to controls, it was not statistically significant.

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