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Gonzalez-Diaz SN, Sanchez-Borges M, Rangel-Gonzalez DM, Guzman-Avilan RI, Canseco-Villarreal JI, Arias-Cruz A. Chronic urticaria and thyroid pathology. World Allergy Organ J 2020; 13:100101. [PMID: 32180891 PMCID: PMC7063156 DOI: 10.1016/j.waojou.2020.100101] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/27/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022] Open
Abstract
Urticaria is defined as the sudden appearance of erythematous, itchy wheals of variable size, with or without angioedema (AE) (swelling of the deeper layers of the skin). Its classification depends on time course of symptoms and the presence of eliciting factors. When it lasts less than 6 weeks it is classified as acute urticaria (AU), and if the symptoms persist for more than 6 weeks, it is classified as chronic urticaria (CU). Current International Guidelines also classify CU as chronic spontaneous urticaria (CSU) and inducible urticarial, according to the absence or presence of environmental triggering factors. CSU is defined as urticaria and/or angioedema in which there is no evidence of a specific eliciting factor. CSU is associated with autoimmunity in 30-45% of the cases, sharing some immunological mechanisms with other autoimmune diseases, and is associated with autoimmune thyroid disease (ATD) in about 4.3%-57.4% patients. Several studies suggest that adequate therapy with anti-thyroid drugs or levothyroxine in early stages of ATD and CSU, may help to remit the latter; but there is still a lack of double-blind, placebo-controlled studies that support this hypothesis in patients without abnormal thyroid hormone levels. The objective of this review is to describe the pathophysiology of chronic spontaneous urticaria and its association with autoimmune thyroid disease.
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Key Words
- AAbs, autoantibodies
- AD, autoimmune diseases
- AE, angioedema
- AMA, antithyroid microsomal antibody
- ASST, autologous serum skin test
- ATAbs, anti-thyroid autoantibodies
- ATD, autoimmune thyroid disease
- Autoimmunity
- BAT, basophil activation test
- CAU, chronic autoimmune urticaria
- CSU, chronic spontaneous urticaria
- CU, chronic urticaria
- Chronic urticaria
- DAMPs, damage-associated molecular patterns
- FcεRIa, high affinity IgE receptor
- GD, Graves' disease
- HT, Hashimoto's thyroiditis/autoimmune thyroiditis
- Histamine
- ICU, inducible chronic urticaria
- IFN-γ, gamma interferon
- IL, Interleukin
- IgE, Immunoglobulin E
- IgG, Immunoglobulin G
- Levothyroxine
- NSAH, non-sedating antihistamines
- PAF, platelet activating factor
- PAMPs, pathogen-associated molecular patterns
- T4L, free thyroxine
- TG, thyroglobulin
- TGAbs, anti-thyroglobulin antibodies
- TLR, Toll-like receptors
- TNF-α, tumor necrosis factor alpha
- TPOAbs, anti-thyroid peroxidase antibodies
- TSH, thyroid stimulating hormone
- TSHR, thyroid stimulating hormone receptor
- Thyroid disease
- Treg, regulatory T cells
- UAS, urticaria activity score
- Urticaria
- VEGF, vascular endothelial growth factor
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Affiliation(s)
- Sandra Nora Gonzalez-Diaz
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Allergy Service, Clinica El Avila, 6a. Transversal Urb. Altamira, Piso 8, Consultorio 803, Caracas, 1060, Venezuela
| | - Diana Maria Rangel-Gonzalez
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Rosa Ivett Guzman-Avilan
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Jose Ignacio Canseco-Villarreal
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Alfredo Arias-Cruz
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
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Criado PR, Criado RFJ, Maruta CW, Reis VMSD. Chronic urticaria in adults: state-of-the-art in the new millennium. An Bras Dermatol 2015; 90:74-89. [PMID: 25672302 PMCID: PMC4323701 DOI: 10.1590/abd1806-4841.20153509] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/04/2014] [Indexed: 11/21/2022] Open
Abstract
Chronic urticaria has been explored in several investigative aspects in the new
millennium, either as to its pathogenesis, its stand as an autoimmune or
auto-reactive disease, the correlation with HLA-linked genetic factors, especially
with class II or its interrelation with the coagulation and fibrinolysis systems. New
second-generation antihistamines, which act as good symptomatic drugs, emerged and
were commercialized over the last decade. Old and new drugs that may interfere with
the pathophysiology of the disease, such as cyclosporine and omalizumab have been
developed and used as treatments. The purpose of this article is to describe the
current state of knowledge on aspects of chronic urticaria such as, pathophysiology,
diagnosis and the current therapeutic approach proposed in the literature.
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