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

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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What Basophil Testing Tells Us About CSU Patients – Results of the CORSA Study

Frontiers in Immunology ◽

10.3389/fimmu.2021.742470 ◽

2021 ◽

Vol 12 ◽

Author(s):

João Marcelino ◽

Katrine Baumann ◽

Per Stahl Skov ◽

Maria Conceição Pereira Santos ◽

Inga Wyroslak ◽

...

Keyword(s):

Disease Activity ◽

Poor Response ◽

Basophil Activation Test ◽

Cross Sectional Study ◽

Chronic Spontaneous Urticaria ◽

Autologous Serum ◽

Total Serum ◽

Thyroid Autoantibodies ◽

Cross Sectional ◽

Autologous Serum Skin Test

Basophil testing is the most effective single approach for diagnosing type-IIb autoimmune chronic spontaneous urticaria (TIIbaiCSU). A positive basophil test has been linked to long disease duration, higher disease activity, a poor response to antihistamines and omalizumab, and a better response to cyclosporine and fenebrutinib. As of now it is unclear what other features are connected to a positive basophil test in chronic spontaneous urticaria (CSU). We aimed to identify features of basophil test-positive CSU patients. We performed a cross-sectional study of 85 CSU patients. Basophil testing was done with the basophil activation test (BAT) and the basophil histamine release assay (BHRA). Data were analysed using SPSS: Student’s t-test, Chi-square test, Odds Ratio, Spearman’s correlation test. Of 85 CSU patients, 44% and 28% tested positive with the BAT and BHRA, respectively. These patients showed higher disease activity and impact, lower levels of disease control and total serum IgE, as well as higher rates of having a positive autologous serum skin test (ASST), angioedema, nocturnal symptoms, symptoms for >5 days/week, and thyroid autoantibodies. The ASST, by itself, was not a good predictor of basophil test results, but it predicted a positive basophil test in up to 100% of cases when combined with angioedema, thyroid autoantibodies or low IgE. In conclusion, a positive basophil test is linked to known features of TIIbaiCSU and novel characteristics including nocturnal symptoms. Further studies on basophil test-positive and -negative CSU patients can help to better understand CSU endotypes and to develop better management approaches.

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Faculty Opinions recommendation of Eosinopenia, in Chronic Spontaneous Urticaria, Is Associated with High Disease Activity, Autoimmunity, and Poor Response to Treatment.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736524970.793573579 ◽

2020 ◽

Author(s):

Riccardo Asero

Keyword(s):

Disease Activity ◽

Poor Response ◽

Chronic Spontaneous Urticaria ◽

High Disease Activity ◽

Response To Treatment

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Faculty Opinions recommendation of Eosinopenia, in Chronic Spontaneous Urticaria, Is Associated with High Disease Activity, Autoimmunity, and Poor Response to Treatment.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736524970.793565846 ◽

2019 ◽

Author(s):

Michihiro Hide

Keyword(s):

Disease Activity ◽

Poor Response ◽

Chronic Spontaneous Urticaria ◽

High Disease Activity ◽

Response To Treatment

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Basophil Markers for Identification and Activation in the Indirect Basophil Activation Test by Flow Cytometry for Diagnosis of Autoimmune Urticaria

Annals of Laboratory Medicine ◽

10.3343/alm.2016.36.1.28 ◽

2016 ◽

Vol 36 (1) ◽

pp. 28-35 ◽

Cited By ~ 14

Author(s):

Zehwan Kim ◽

Bong Seok Choi ◽

Jong Kun Kim ◽

Dong Il Won

Keyword(s):

Flow Cytometry ◽

Basophil Activation Test ◽

Basophil Activation ◽

Activation Test ◽

Autoimmune Urticaria

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Angioedema severity and impacts on quality of life: chronic histaminergic angioedema versus chronic spontaneous urticaria

10.22541/au.163256814.44135646/v1 ◽

2021 ◽

Author(s):

Marina Sabate-Bresco ◽

Nuria Rodríguez-Garijo ◽

JULIÁN AZOFRA ◽

María L. Baeza ◽

Carmen Diaz Donado ◽

...

Keyword(s):

Quality Of Life ◽

Disease Activity ◽

Chronic Spontaneous Urticaria ◽

C Reactive Protein ◽

Prospective Multicenter Study ◽

Reactive Protein ◽

Female Predominance ◽

Patient Reported ◽

Considerable Impact

Background: Chronic histaminergic angioedema (CHA) is defined as recurrent episodes of isolated angioedema (without hives) of unknown cause that respond to the same treatment as chronic spontaneous urticaria (CSU). Quality of life (QoL) studies have not been performed for CHA, except those carried out in the context of CSU associated with angioedema attacks (CSU-AE). Moreover, biomarkers for monitoring disease activity in CHA have not been identified. We aim to describe the burden of CHA and impact on patient QoL, compare the findings to those in CSU-AE patients, and investigate biomarker associations with disease severity and QoL parameters. Methods: We performed a prospective multicenter study that included 68 patients with CHA and 63 patients with CSU-AE. Demographic and clinical variables were collected. Validated patient-reported questionnaires were employed to analyze the quality of life and disease activity. Blood and serological parameters, including blood cell count, C-reactive protein, D-dimer and total IgE, were also analyzed. Results: Angioedema disease activity was significantly higher in CSU-AE patients (median AAS7, IQR: 1, [0–1]) than CHA patients (0, [0–1]; p= 0.022). A considerable impact on QoL was found in both groups, although significantly worse values were found for CSU-AE (median AEQoL, IQR: 37, [10–65]; p=0.005). CHA patients were older than CSU-AE patients, and female predominance was not observed. Conclusions: Angioedema severity and QoL impacts are significantly worse in CSU than in chronic histaminergic angioedema. Angioedema should be included in severity urticaria scores (UAS) as well as in specific quality of life urticaria scales.

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