Elevated Serum Total IgE – A Potential Marker for Severe Chronic UrticariaKessel A.a · Helou W.a · Bamberger E.a · Sabo E.a · Nusem D.b · Panassof J.b · Toubi E.a
aDivision of Allergy and Clinical Immunology, Bnai Zion Medical Center, Technion Faculty of Medicine and bClalit Health Services, Lin Medical Center, Allergy, Haifa, Israel
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Article / Publication Details
Background: Elevated IgE levels in patients with chronic urticaria have been noted previously, but the significance of these findings has not been appreciated. Objective: To measure the IgE levels in such patients and to examine the relationship between these levels and urticarial severity, autologous serum skin test, anti-thyroid antibodies and duration. Methods: Serum total IgE levels from 203 patients with chronic urticaria were measured and compared with nonatopic individuals. Additionally, patients were assessed for urticarial severity, the presence of autologous serum skin test and anti-thyroid antibodies. Results: Of the chronic urticaria patients, 47 (23.2%) were classified as mild, whereas 67 (33%) were classified as having moderate and 89 (43.8%) as having severe chronic urticaria. Total IgE levels were elevated, above 175 U/ml, in 69/203 (34%) of patients, compared with 7/81 (8.6%) of healthy controls (p < 0.001). A significant association between increased total IgE and chronic urticaria severity was found. Whereas 93% of patients with increased level of total IgE suffered from moderate-to-severe chronic urticaria, this was observed in only 69% of patients with normal IgE (p < 0.0001). Autologous serum skin test and anti-thyroid antibodies were positive in 59/163 (36%) and 28/189 (15%) patients, respectively. A significant association between increased total IgE levels and the presence of autologous serum skin test, anti-thyroid antibodies and urticarial duration lasting more than 25 months (p < 0.0001, p < 0.0001 and p = 0.021, respectively) was also detected. Conclusions: Total serum IgE levels are frequently elevated in patients with chronic urticaria and these are associated with disease severity and duration.
© 2010 S. Karger AG, Basel
- Powell RJ, Du Toit GL, Siddique N, Leech SC, Dixon TA, Clark AT, Mirakian R, Walker SM, Huber PA, Nasser SM: BSACI guidelines for the management of chronic urticaria and angio-oedema. Clin Exp Allergy 2007;37:631–650.
- Hide M, Francies DM, Grattan CEH, Hakimi J, Kacham JP, Greave MW: Autoantibodies against the high affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 1993;328:1599–1604.
- Grattan CE, Francis DM, Hide M, Greave MW: Detection of circulating histamine releasing autoantibodies with functional properties of anti-IgE in chronic urticaria. Clin Exp Allergy 1991;21:695–704.
- Gruber B, Poznansky M, Boss E, Partin J, Gorevic P, Kaplan AP: Characterization and functional studies of rheumatoid synovial mast cells. Activation by secretagogues, anti-IgE, and a histamine-releasing lymphokine. Arthritis Rheum 1986;29:944–955.
- Tong LJ, BalakrishnanG, Kochan JP, Kinet J-P, Kaplan AP: Assessment of autoimmunity in patients with chronic urticaria. J Allergy Clin Immunol 1997;99:461–465.
- Kaplan AP: Chronic urticaria: pathogenesis and treatment. J Allergy Clin Immunol 2004;114:465–474.
- Toubi E, Adir-Shani A, Kessel A, Shmuel Z, Sabo E, Hacham H: Immune aberrations in B and T lymphocytes derived from chronic urticaria patients. J Clin Immunol 2000;20:371–378.
- Confino-Cohen R, Aharoni D, Goldberg A, Gurevitch I, Buchs A, Weiss M, Weissgarten J, Rapoport MJ: Evidence for aberrant regulation of the p21Ras pathway in PBMCs of patients with chronic idiopathic urticaria. J Allergy Clin Immunol 2002;109:349–355.
- Kessel A, Bishara R, Amital A, Bamberger E, Sabo E, Grushko G, Toubi E: Increased plasma levels of matrix MMP-9 are associated with the severity of chronic urticaria. Clin Exp Allergy 2005;35:221–225.
- Toubi E, Kessel A, Avshovich N, Bamberger E, Sabo E, Nusem D, Panasoff J: Clinical and laboratory parameters in predicting chronic urticaria duration: a prospective study of 139 patients. Allergy 2004;59:869–873.
- Volonakis M, Katsarou-Katsari A, Stratigos J: Etiologic factors in childhood chronic urticaria. Ann Allergy 1992;69:61–65.
- Liutu M, Kalimo K, Uksila J, Kalimo H: Etiologic aspects of chronic urticaria. Int J Dermatol 1998;37:515–519.
- Sackesen C, Sekerel BE, Orhan F, Kocabas CN, Tuncer A, Adalioglu G: The etiology of different forms of urticaria in childhood. Pediatr Dermatol 2004;21:102–108.
- Brunetti L, Francavilla R, Miniello VL, Platzer MH, Rizzi D, Lospalluti ML, Poulsen LK, Armenio L, Skov PS: High prevalence of autoimmune urticaria in children with chronic urticaria. J Allergy Clin Immunol 2004;114:922–927.
- Sabroe RA, Grattan CEI, Francis DM, Barr RM, Black AK, Greaves MW: The autologous serum skin test: a screening test for autoantibodies in chronic idiopathic urticaria. Br J Dermatol 1999;140:446–452.
- Pepys J: Skin tests for immediate, type I allergic reactions. Proc R Soc Med 1972;65:271–272.
- Breneman D, Bronsky AK, Bruce S: Cetirizine and astemisone therapy for chronic urticaria: a double-blind, placebo-controlled, comparative trial. J Am Acad Dermatol 1995;33:192–198.
- Hetman S, Kivity S, Greif J, Fireman EM, Topilsky M: IgE values in the allergic and healthy Israeli population. Ann Allergy 1988;61:123–128.
- Droste JH, Kerhof M, de Monchy JG, Schouten JP, Rijcken B: Association of skin test reactivity, specific IgE, total IgE, and eosinophils with nasal symptoms in a community-based population study. The Dutch ECRHS Group. J Allergy Clin Immunol 1996;97:922–932.
- Holgate S, Casale T, Wenzel S, Bousquet J, Deniz Y, Reisner C: The anti-inflammatory effects of omalizumab confirm the central role of IgE in allergic inflammation. J Allergy Clin Immunol 2005;115:459–465.
- Spector SL, Tan RA: Effects of omalizumab on patients with chronic urticaria. Ann Allergy Asthma Immunol 2007;99:190–193.
- Kaplan AP, Joseph K, Maykut RJ, Geba GP, Zeldin RK: Treatment of chronic autoimmune urticaria with omalizumab. J Allergy Clin Immunol 2008;122:569–573.
- Sands MF, Blume JW, Schwartz SA: Successful treatment of 3 patients with recurrent idiopathic angioedema with omalizumab. J Allergy Clin Immunol 2007;120:979–981.
- Dreyfus DH: Observations on the mechanism of omalizumab as a steroid-sparing agent in autoimmune or chronic idiopathic urticaria and angioedema. Ann Allergy Asthma Immunol 2008;100:624–625.
- Godse KV: Omalizumab in severe chronic urticaria. Indian J Dermatol Venereol Leprol 2008;74:157–158.
- Kawakami T, Kitaura J: Mast cell survival and activation by IgE in the absence of antigen: a consideration of the biologic mechanisms and relevance. J Immunol 2005;175:4167–4173.
- Kitaura J, Eto K, Kinoshita T, Kawakami Y, Leitges M, Lowell CA, Kawakami T: Regulation of highly cytokinergic IgE-induced mast cell adhesion by Src, Syk, Tec, and protein kinase C family kinases. J Immunol 2005;174:4495–4504.
- Kashiwakura JI, Xiao W, Kitaura J, Kawakami Y, Maeda-Yamamoto M, Pfeiffer JR, Wilson BS, Blank U, Kawakami T: Pivotal advance: IgE accelerates in vitro development of mast cells and modifies their phenotype. J Leukoc Biol 2008;84:357–367.
- Prussin C, Griffith DT, Boesel KM, Lin H, Foster B, Casale TB: Omalizumab treatment downregulates dendritic cell FcepsilonRI expression. J Allergy Clin Immunol 2003;112:1147–1154.
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