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An YP, Yuan R, Wang SS, Yang SQ, Zhang Q. Knockdown of miR-155 alleviates skin damage in rats with chronic spontaneous urticaria by modulating the JAK/STAT signaling pathway. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:38. [PMID: 38951930 DOI: 10.1186/s13223-024-00902-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/12/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the role and mechanisms of miR-155 in chronic spontaneous urticaria (CSU). METHODS The expression level of miR-155 in the skin tissues of patients with CSU and experimental rats were detected by RT-qPCR, followed by the measurement of the histamine release rate in the serum through the histamine release test. Besides, hematoxylin & eosin staining was used to observe the pathological changes of the skin tissues; Corresponding detection kits and flow cytometry to measure the changes of immunoglobulins, inflammatory cytokines and T cell subsets in the serum of rats in each group; and western blot to check the expression level of proteins related to JAK/STAT signaling pathway in the skin tissues. RESULTS Knockdown of miR-155 reduced the number and duration of pruritus, alleviated the skin damage, and decreased the number of eosinophils in CSU rats. Moreover, knockdown of miR-155 elevated the serum levels of IgG and IgM, decreased the levels of IgA and inflammatory cytokines, and reduced the proportion of CD4 + and CD4 + CD25 + T cells, as well as the CD4+/CD8 + ratio in CSU rats. However, Tyr705 intervention could reverse the effects of knockdown of miR-155 on CSU model rats. Furthermore, we found that knockdown of miR-155 significantly reduced the protein expression of IRF-9, as well as the P-JAK2/JAK2 and P-STAT3/STAT3 ratios in the skin tissues of CSU rats. CONCLUSION Knockdown of miR-155 can alleviate skin damage and inflammatory responses and relieve autoimmunity in CSU rats by inhibiting the JAK/STAT3 signaling pathway.
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Affiliation(s)
- Yue-Peng An
- Department of Dermatology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, No. 26 Heping Road, Xiangfang District, Harbin, 150040, Heilongjiang, China
| | - Rui Yuan
- Department of Dermatology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, No. 26 Heping Road, Xiangfang District, Harbin, 150040, Heilongjiang, China
| | - Shan-Shan Wang
- Department of Dermatology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, No. 26 Heping Road, Xiangfang District, Harbin, 150040, Heilongjiang, China
| | - Su-Qing Yang
- Department of Dermatology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, No. 26 Heping Road, Xiangfang District, Harbin, 150040, Heilongjiang, China
| | - Qing Zhang
- Department of Dermatology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, No. 26 Heping Road, Xiangfang District, Harbin, 150040, Heilongjiang, China.
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Wills S, Chavez J, Grover A, Beck N, Romano M, Bauer C, Gerspach M, Schneider M, Valcour A. PD-BAT: A novel approach of pooling basophil donors for expansion of commercial laboratory testing of Chronic Spontaneous Urticaria. J Immunol Methods 2024; 529:113679. [PMID: 38679364 DOI: 10.1016/j.jim.2024.113679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
The type II autoimmune subtype of Chronic Spontaneous Urticaria (CSU) is characterized by the presence of IgG autoantibodies targeting IgE or the IgE high-affinity receptor (FcεRI) on mast cells and basophils. In evaluation of CSU patients, indirect basophil activation testing (BAT), has been utilized, involving the mixing of patient serum with heterologous peripheral blood donors, followed by flow cytometric assessment of basophil markers. However, the reliability of the indirect BAT results hinges on the quality of the donor basophils utilized. In this study, we introduce an innovative approach where multiple potential basophil donors undergo rigorous BAT characterization alongside control samples. By selecting and pooling donors with optimal performance, we significantly enhance the inter-assay reproducibility of the indirect BAT test.
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Affiliation(s)
| | | | - Ajay Grover
- Labcorp, Burlington, NC, United States of America
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Bhowmik R, Shaharyar MA, Sarkar A, Mandal A, Anand K, Shabana H, Mitra A, Karmakar S. Immunopathogenesis of urticaria: a clinical perspective on histamine and cytokine involvement. Inflamm Res 2024; 73:877-896. [PMID: 38555555 DOI: 10.1007/s00011-024-01869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Urticaria is a clinical condition characterized by the appearance of wheals (hives), angioedema, or both. Over the last several decades, a better understanding of the mechanisms at play in the immunopathogenesis of urticaria has underscored the existence of numerous urticaria subtypes. Separating the different kinds of urticaria explicitly helps find the best detection method for the management of this skin disorder. Subtypes of urticaria also include both spontaneous and physical types. The conventional ones include spontaneous urticaria, constituting both acute and chronic urticaria. Therefore, a broad and effective therapy is essential for the diagnosis and treatment of urticaria. METHODS To understand the immunopathogenesis of urticaria, various databases, including PubMed, Scopus, and Web of Science, were used to retrieve original articles and reviews related to urticaria. While information on several clinical trials were obtained from clinicaltrials.gov database. RESULTS This article highlights the immunopathogenesis involved in the intricate interaction between cellular infiltration, immune reactions, coagulation cascades, and autoantibodies that underlie urticaria's pathophysiology. CONCLUSION The recent progress in understanding urticaria can help to understand the intricate characteristics in the immunopathogenesis of urticaria and could play a beneficial role in the management of urticaria.
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Affiliation(s)
- Rudranil Bhowmik
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Md Adil Shaharyar
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Arnab Sarkar
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Avishek Mandal
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Kumar Anand
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Humira Shabana
- Chaudhary Charan Singh University, Formerly, Meerut University, Meerut, Uttar Pradesh, India
| | - Achintya Mitra
- Regional Ayurveda Research Institute (RARI) CCRAS Under Ministry of AYUSH, Thapla, Ganiyadeoli, Ranikhet Almora, Uttarakhand, India
| | - Sanmoy Karmakar
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India.
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4
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Momin ZK, Chambliss JM. Chronic spontaneous urticaria preceded by localized insulin reactions: case report. SAGE Open Med Case Rep 2024; 12:2050313X241248383. [PMID: 38655126 PMCID: PMC11036908 DOI: 10.1177/2050313x241248383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
Chronic spontaneous urticaria presents with wheals and/or angioedema for >6 weeks without any specific triggers. The incidence of chronic spontaneous urticaria is increased in patients with comorbid autoimmune conditions. Here, we present a case of chronic spontaneous urticaria in a 9-year-old with type 1 diabetes and autoimmune thyroid disease who first presented with insulin pump site reactions concerning an insulin-related allergy. The patient was successfully treated with antihistamines and later immunosuppression with resumption of insulin pump therapy and remission of chronic spontaneous urticaria symptoms 18 months after onset.
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Affiliation(s)
- Zoha K. Momin
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey M. Chambliss
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Angeli I, Vassilopoulou E, Cassimos D, Fotopoulos I, Serbis A, Alexandros M, Tsabouri S. Blood Adhesion Molecules as Biomarkers in Children with Chronic Urticaria. CHILDREN (BASEL, SWITZERLAND) 2024; 11:449. [PMID: 38671667 PMCID: PMC11048842 DOI: 10.3390/children11040449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/18/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The prevailing etiological model of both acute and chronic urticaria implicates specific allergen exposure that triggers the local release of vasoactive factors and inflammatory adhesion molecules, including vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), endothelial leukocyte adhesion molecule 1 (ELAM-1), P-selectin and E-selectin in the superficial dermis. This study focused on the possible role of VCAM-1 and ICAM-1 as biomarkers in children with acute and chronic urticaria. METHODS This study involved 184 children, 40 with acute urticaria, 71 with chronic urticaria, and 73 matched comparison subjects. The serum levels of ICAM-1 and VCAM-1 were determined in venous blood in all the participants on enrollment. Antihistamine treatment was administered to all the patients. In the children with chronic urticaria, the Urticaria Activity Score Questionnaire (UAS7) was completed daily by the parents. In 16 of the patients with acute urticaria and 43 with chronic urticaria, the serum levels of ICAM-1 and VCAM-1 were determined at follow-up after 6-8 weeks of treatment. RESULTS The mean serum levels of both VCAM-1 and ICAM-1 were higher in both groups of children with urticaria than in the comparison subjects at the start of the study. In the chronic urticaria group, the levels decreased significantly (p = 0.03 and p = 0.01, respectively) following treatment. Similarly, the acute urticaria group exhibited significant reduction in the mean levels of VCAM and ICAM (p < 0.001). In both groups, the mean level of ICAM after treatment was comparable with that of the comparison group. CONCLUSIONS VCAM-1 and ICAM-1 are suggested as promising biomarkers for monitoring both acute and chronic urticaria in children. Future research should explore their utility in larger cohorts and investigate their role in personalized treatment strategies.
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Affiliation(s)
- Ioanna Angeli
- Department of Pediatrics, School of Medicine, University of Ioannina, 45332 Ioannina, Greece; (I.A.); (S.T.)
| | - Emilia Vassilopoulou
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Dimitrios Cassimos
- Pediatric Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Ioannis Fotopoulos
- Department of Computer Science, University of Crete, Voutes Campus, 70013 Heraklion, Greece;
| | - Anastasios Serbis
- Department of Pediatrics, School of Medicine, University of Ioannina, 45332 Ioannina, Greece; (I.A.); (S.T.)
| | - Makis Alexandros
- Department of Pediatrics, School of Medicine, University of Ioannina, 45332 Ioannina, Greece; (I.A.); (S.T.)
| | - Sophia Tsabouri
- Department of Pediatrics, School of Medicine, University of Ioannina, 45332 Ioannina, Greece; (I.A.); (S.T.)
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Guo H, Guo L, Li L, Li N, Lin X, Wang Y. Identification of key genes and molecular mechanisms of chronic urticaria based on bioinformatics. Skin Res Technol 2024; 30:e13624. [PMID: 38558219 PMCID: PMC10982677 DOI: 10.1111/srt.13624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 04/04/2024]
Abstract
Chronic urticaria (CU) is characterized by persistent skin hives, redness, and itching, enhanced by immune dysregulation and inflammation. Our main objective is identifying key genes and molecular mechanisms of chronic urticaria based on bioinformatics. We used the Gene Expression Omnibus (GEO) database and retrieved two GEO datasets, GSE57178 and GSE72540. The raw data were extracted, pre-processed, and analyzed using the GEO2R tool to identify the differentially expressed genes (DEGs). The samples were divided into two groups: healthy samples and CU samples. We defined cut-off values of log2 fold change ≥1 and p < .05. Analyses were performed in the Kyoto Encyclopaedia of Genes and Genomes (KEGG), the Database for Annotation, Visualization and Integrated Discovery (DAVID), Metascape, Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) and CIBERSOFT databases. We obtained 1613 differentially expressed genes. There were 114 overlapping genes in both datasets, out of which 102 genes were up-regulated while 12 were down-regulated. The biological processes included activation of myeloid leukocytes, response to inflammations, and response to organic substances. Moreover, the KEGG pathways of CU were enriched in the Nuclear Factor-Kappa B (NF-kB) signaling pathway, Tumor Necrosis Factor (TNF) signaling pathway, and Janus kinase/signal transducers and activators of transcription (JAK-STAT) signaling pathway. We identified 27 hub genes that were implicated in the pathogenesis of CU, such as interleukin-6 (IL-6), Prostaglandin-endoperoxide synthase 2 (PTGS2), and intercellular adhesion molecule-1 (ICAM1). The complex interplay between immune responses, inflammatory pathways, cytokine networks, and specific genes enhances CU. Understanding these mechanisms paves the way for potential interventions to mitigate symptoms and improve the quality of life of CU patients.
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Affiliation(s)
- Haichao Guo
- Department of Acupuncture and MoxibustionThe First Affiliated Hospital of Hebei University of Chinese MedicineShijiazhuangHebeiChina
- Department of DermatologyXingtai Hospital of Traditional Chinese MedicineXingtaiHebeiChina
| | - Lifang Guo
- Department of DermatologyXingtai Hospital of Traditional Chinese MedicineXingtaiHebeiChina
| | - Li Li
- Department of DermatologyXingtai Hospital of Traditional Chinese MedicineXingtaiHebeiChina
| | - Na Li
- Department of PsychiatryThe First Affiliated Hospital of Hebei University of Chinese MedicineShijiazhuangHebeiChina
| | - Xiaoyun Lin
- Department of Acupuncture and MoxibustionThe First Affiliated Hospital of Hebei University of Chinese MedicineShijiazhuangHebeiChina
| | - Yanjun Wang
- Department of Acupuncture and MoxibustionThe First Affiliated Hospital of Hebei University of Chinese MedicineShijiazhuangHebeiChina
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Zhang F, Liao J, Qian Y, Niu X, Wei J, Li M, Guo D, Zhu P. Real-World Effectiveness of Omalizumab in Chronic Urticaria: A Clinical Observational Study. Int Arch Allergy Immunol 2024; 185:718-728. [PMID: 38513629 PMCID: PMC11216351 DOI: 10.1159/000538011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION The purpose of this study was to assess the clinical effectiveness and safety profile of omalizumab as a therapeutic intervention for chronic urticaria (CU). METHODS From March 1, 2023, to September 30, 2023, data on a cohort comprising 96 patients with CU, who underwent treatment with omalizumab at our medical institution's allergy clinic, were systematically compiled. Subsequent to the administration of omalizumab, the therapeutic efficacy was assessed utilizing the 7-day urticaria activity score and the urticaria control test. RESULTS Based on the statistical analysis, the mean duration of therapeutic intervention was 2.4 ± 1.3 months, with a corresponding mean cumulative dosage of 765 ± 450 mg. Of the subset of 42 patients with CU who were subjected to a follow-up period exceeding 3 months, it was observed that the treatment led to complete symptom remission, and no instances of recurrence were documented. Notably, there were statistically significant differences in the treatment duration and the cumulative dosage between patients who experienced co-morbid conditions and those who did not (p < 0.01, 95% CI: 0.280-1.326; p < 0.01, 95% CI: 0.597-2.997). Furthermore, there were significant differences in the treatment duration and cumulative dosage between patients in the combined allergic rhinitis group and those in the non-combined allergic rhinitis group (p < 0.01, 95% CI: 0.204-1.305; p = 0.01, 95% CI: 0.326-2.860). CONCLUSION Omalizumab demonstrates efficacy in the management of CU among Chinese patients by exerting effective symptom control and facilitating the regression of skin lesions. The assessment of its therapeutic efficacy typically requires a 12-week treatment period. Moreover, the co-occurrence of CU with other allergic disorders serves as a pertinent consideration for the adjustment of omalizumab dosing regimens.
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Affiliation(s)
- Fan Zhang
- Department of Dermatology and Venereology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Jiashun Liao
- Peking University School of Medicine, School of Clinical Medicine, Beijing, China
| | - Yuan Qian
- Peking University School of Medicine, School of Clinical Medicine, Beijing, China
| | - Xinyu Niu
- Peking University School of Medicine, School of Clinical Medicine, Beijing, China
| | - Jia Wei
- Department of Dermatology and Venereology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Man Li
- Department of Dermatology and Venereology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Duyi Guo
- Department of Dermatology and Venereology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Peiqiu Zhu
- Department of Dermatology and Venereology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
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Ryan C, Li K, Bennett R, Davis MJ, Shaker M, Hsu Blatman K, Hughes S, Mann JA. Chronic urticaria after Moderna COVID-19 vaccine boosters: A case series. JAAD Case Rep 2024; 45:27-30. [PMID: 38379871 PMCID: PMC10876461 DOI: 10.1016/j.jdcr.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Affiliation(s)
- Chenin Ryan
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kevin Li
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Raven Bennett
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Matthew J. Davis
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Marcus Shaker
- Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Karen Hsu Blatman
- Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Sarah Hughes
- Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Julianne A. Mann
- Departments of Dermatology and Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
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Chen Q, Yang X, Ni B, Song Z. Atopy in chronic urticaria: an important yet overlooked issue. Front Immunol 2024; 15:1279976. [PMID: 38380314 PMCID: PMC10876790 DOI: 10.3389/fimmu.2024.1279976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
Chronic urticaria (CU) is one of the most common dermatological diseases and has a significant impact on the quality of life of patients. However, the pathogenesis of this disease remains unclear. Autoimmunity in chronic spontaneous urticaria (CSU) has received considerable attention and has been studied previously. Atopy is an important characteristic of CU; however, it has not been fully recognized. Atopy predisposes individuals to immune responses to allergens, leading to type 2 inflammation and immunoglobulin E (IgE) overproduction. Compared with healthy individuals, patients with CU have a higher proportion of atopy, and an atopic background is correlated with the clinical characteristics of CU. The total IgE levels in patients with CU is significantly higher than those in healthy individuals. Although its level is not higher than that in classic allergic diseases, it is closely related to CU. Exogenous allergens, auto-allergens, and specific IgEs, which are closely related to atopy, have been reported, and their roles in CU pathogenesis are also being studied. Local and systemic atopic inflammation is present in patients with CU. This review summarizes the current knowledge regarding atopy and CU, speculating that there are CU subtypes, such as atopic CSU or atopic chronic inducible urticaria (CIndU) and that atopy may be involved in the pathogenesis of CU. These findings provide a new perspective for a comprehensive understanding of the clinical features of CU and further research regarding its pathogenesis.
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Affiliation(s)
- Qiquan Chen
- Department of Dermatology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xianjie Yang
- Department of Dermatology, Southwest Hospital, Army Medical University, Chongqing, China
- School of Medicine, Chongqing University, Chongqing, China
| | - Bing Ni
- Department of Pathophysiology, Army Medical University, Chongqing, China
| | - Zhiqiang Song
- Department of Dermatology, Southwest Hospital, Army Medical University, Chongqing, China
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Kovalkova E, Fomina D, Borzova E, Maltseva N, Chernov A, Serdoteckova S, Weller K, Maurer M. Comorbid Inducible Urticaria Is Linked to Non-Autoimmune Chronic Spontaneous Urticaria: CURE Insights. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:482-490.e1. [PMID: 38008357 DOI: 10.1016/j.jaip.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Patients with chronic spontaneous urticaria (CSU) can have comorbid inducible urticaria (CIndU). How comorbid CIndU affects patients and their CSU is largely unclear. OBJECTIVE To compare patients with CSU with and without comorbid CIndUs for differences in demographic features, clinical characteristics, and laboratory markers. METHODS We analyzed 708 patients with CSU of our Urticaria Center of Reference and Excellence enrolled in CURE, the chronic urticaria registry. CURE data collected until October 2022 were used to compare patients with and without comorbid CIndU for their demographic characteristics, disease onset, activity, impact, and control, as well as concomitant allergic and autoimmune diseases and laboratory parameters associated with autoimmune CSU. RESULTS Of 708 patients with CSU, 247 (35%) had comorbid CIndU. Compared with patients with standalone CSU, patients with CSU with comorbid CIndU were significantly younger, had earlier disease onset, longer disease duration, higher impact on quality of life, and a higher rate of concomitant allergic diseases. Moreover, patients with CSU with comorbid CIndU less often had features linked to autoimmune CSU such as angioedema, concomitant autoimmune diseases, eosinopenia, low levels of total IgE, and low total IgE combined with elevated anti-thyroid peroxidase IgG. CONCLUSIONS Autoimmune CSU may be less common in patients with comorbid CIndU than without, and comorbid CIndU may point to autoallergic CSU.
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Affiliation(s)
- Elena Kovalkova
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia.
| | - Daria Fomina
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia; Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Department of Pulmonology, Astana Medical University, Astana, Kazakhstan
| | - Elena Borzova
- Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Dermatology Division, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Natalya Maltseva
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia
| | - Anton Chernov
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia
| | - Sofia Serdoteckova
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia
| | - Karsten Weller
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marcus Maurer
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
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Lerner L, Babina M, Zuberbier T, Stevanovic K. Beyond Allergies-Updates on The Role of Mas-Related G-Protein-Coupled Receptor X2 in Chronic Urticaria and Atopic Dermatitis. Cells 2024; 13:220. [PMID: 38334612 PMCID: PMC10854933 DOI: 10.3390/cells13030220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/14/2023] [Accepted: 01/19/2024] [Indexed: 02/10/2024] Open
Abstract
Mast cells (MCs) are an important part of the immune system, responding both to pathogens and toxins, but they also play an important role in allergic diseases, where recent data show that non-IgE-mediated activation is also of relevance, especially in chronic urticaria (CU) and atopic dermatitis (AD). Skin MCs express Mas-related G-protein-coupled receptor X2 (MRGPRX2), a key protein in non-IgE-dependent MC degranulation, and its overactivity is one of the triggering factors for the above-mentioned diseases, making MRGPRX2 a potential therapeutic target. Reviewing the latest literature revealed our need to focus on the discovery of MRGPRX2 activators as well as the ongoing vast research towards finding specific MRGPRX2 inhibitors for potential therapeutic approaches. Most of these studies are in their preliminary stages, with one drug currently being investigated in a clinical trial. Future studies and improved model systems are needed to verify whether any of these inhibitors may have the potential to be the next therapeutic treatment for CU, AD, and other pseudo-allergic reactions.
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Affiliation(s)
- Liron Lerner
- Institute of Allergology, Charité—Universitätsmedizin Berlin, 12203 Berlin, Germany; (L.L.); (M.B.); (T.Z.)
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, 12203 Berlin, Germany
| | - Magda Babina
- Institute of Allergology, Charité—Universitätsmedizin Berlin, 12203 Berlin, Germany; (L.L.); (M.B.); (T.Z.)
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, 12203 Berlin, Germany
| | - Torsten Zuberbier
- Institute of Allergology, Charité—Universitätsmedizin Berlin, 12203 Berlin, Germany; (L.L.); (M.B.); (T.Z.)
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, 12203 Berlin, Germany
| | - Katarina Stevanovic
- Institute of Allergology, Charité—Universitätsmedizin Berlin, 12203 Berlin, Germany; (L.L.); (M.B.); (T.Z.)
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, 12203 Berlin, Germany
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12
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Özhan AK, Arıkoğlu T. Evaluation of Pediatric Chronic Urticaria with Emphasis on Clinical and Laboratory Characteristics and Treatment Response to Omalizumab: A Real-Life Experience from a Tertiary Allergy Center. CHILDREN (BASEL, SWITZERLAND) 2024; 11:86. [PMID: 38255399 PMCID: PMC10814258 DOI: 10.3390/children11010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
Pediatric data on the clinical and etiologic features, treatment response, and use of omalizumab for chronic urticaria (CU) are quite limited. The aim of this study was to evaluate the clinical and demographic characteristics, laboratory findings, and response to treatment of CU in children. Children with a diagnosis of CU between 2019 and 2023 were included in the study. Information on demographic characteristics, clinical features, laboratory tests, provocation tests for inducible urticaria, urticaria activity scores (UAS7), and treatment responses were obtained from patients' medical records. A total of 150 children (50.7% male) with CU were enrolled in the study. A total of 14 (9.3%) patients had autoimmune diseases of which 11 (7.3%) had autoimmune thyroiditis. Overall, 97 (64.7%) patients had chronic spontaneous urticaria (CSU) and 53 (35.3%) had chronic inducible urticaria. A total of 16 patients who remained symptomatic despite high-dose antihistamines were treated with omalizumab, with a good response in 13 (81.3%) and a partial response in 3 (18.7%) patients. CSU accounts for the majority of pediatric CU, with the etiology being in part related to an autoimmune background. This study provides an overview of CU in children and demonstrates the safety and efficacy of treatment with omalizumab.
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Affiliation(s)
- Aylin Kont Özhan
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin 33110, Turkey;
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13
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Salle R, Skayem C, Longvert C, Castagna J, Soria A, Funck-Brentano E. Persistent nivolumab-induced urticaria with vibratory and delayed-pressure angioedema. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:257-258. [PMID: 37813300 DOI: 10.1016/j.jaip.2023.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 09/10/2023] [Accepted: 09/29/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Romain Salle
- Université Paris-Saclay, UVSQ, EA4340-BECCOH, AP-HP, Department of General and Oncologic Dermatology, Ambroise-Paré Hospital, Boulogne-Billancourt, France
| | - Charbel Skayem
- Université Paris-Saclay, UVSQ, EA4340-BECCOH, AP-HP, Department of General and Oncologic Dermatology, Ambroise-Paré Hospital, Boulogne-Billancourt, France
| | - Christine Longvert
- Université Paris-Saclay, UVSQ, EA4340-BECCOH, AP-HP, Department of General and Oncologic Dermatology, Ambroise-Paré Hospital, Boulogne-Billancourt, France
| | - Julie Castagna
- Department of Dermatology-Venereology and Allergology, Hôpital Tenon, Paris HUEP, APHP, Paris, France; Sorbonne Université, Paris, France; Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM U1135, Paris, France
| | - Angèle Soria
- Department of Dermatology-Venereology and Allergology, Hôpital Tenon, Paris HUEP, APHP, Paris, France; Sorbonne Université, Paris, France; Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM U1135, Paris, France
| | - Elisa Funck-Brentano
- Université Paris-Saclay, UVSQ, EA4340-BECCOH, AP-HP, Department of General and Oncologic Dermatology, Ambroise-Paré Hospital, Boulogne-Billancourt, France.
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14
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Litovsky J, Hacard F, Tétart F, Boccon-Gibod I, Soria A, Staumont-Sallé D, Doutre MS, Amsler E, Mansard C, Dezoteux F, Darrigade AS, Milpied B, Bernier C, Perrot JL, Raison-Peyron N, Paryl M, Droitcourt C, Demoly P, Grosjean J, Mura T, Du-Thanh A. Omalizumab Drug Survival in Chronic Urticaria: A Retrospective Multicentric French Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3752-3762.e2. [PMID: 37652349 DOI: 10.1016/j.jaip.2023.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Omalizumab (OMA) dramatically improves disease control and quality of life in patients with chronic urticaria (CU). OBJECTIVE We aimed to evaluate the discontinuation patterns of OMA and their determinants in a cohort of French patients with CU. METHODS We conducted a retrospective multicenter study in 9 French tertiary referral hospitals. All patients diagnosed with either spontaneous (CSU) and/or inducible (CIndU) CU who received at least 1 injection of OMA between 2009 and 2021 were included. We analyzed OMA drug survival and investigated possible determinants using Kaplan-Meier curves and log-rank tests. RESULTS A total of 878 patients were included in this study; 48.8% had CSU, 10.1% CIndU, and 41.1% a combination of both. OMA was discontinued in 408 patients, but the drug was later reintroduced in 50% of them. The main reason for discontinuing treatment was the achievement of a well-controlled disease in 50% of patients. Half of the patients were still being treated with OMA 2.4 years after the initiation of treatment. Drug survival was shorter in patients with CIndU and in those with an autoimmune background. In atopic patients, OMA was discontinued earlier in patients achieving a well-controlled disease. A longer OMA drug survival was observed in patients with a longer disease duration at initiation. CONCLUSION In French patients with CU, the drug survival of OMA appears to be longer than that observed in previous studies conducted elsewhere, highlighting discrepancies in prescription and reimbursement possibilities. Further studies are warranted to develop customized OMA treatment schemes based on individual patterns.
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Affiliation(s)
- Julie Litovsky
- Département de Dermatologie, C.H.U de Montpellier, Montpellier, France
| | - Florence Hacard
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Allergologie et Immunologie Clinique, Pierre Bénite, France
| | - Florence Tétart
- Centre Erik Satie-Allergologie, Rouen University Hospital, Rouen, France
| | - Isabelle Boccon-Gibod
- Service de Médecine Interne, Centre National de Référence des Angioedèmes, CHU de Grenoble, Échirolles, France
| | - Angèle Soria
- Service de Dermatologie et Allergologie, Hôpital Tenon AP-HP, Sorbonne Université, Paris, France
| | - Delphine Staumont-Sallé
- CHU Lille, Service de Dermatologie, Université de Lille, INSERM U1286, Lille Inflammation Translational Research Institute (INFINITE) F-59000, Lille, France
| | | | - Emmanuelle Amsler
- Service de Dermatologie et Allergologie, Hôpital Tenon AP-HP, Sorbonne Université, Paris, France
| | - Catherine Mansard
- Service de Médecine Interne, Centre National de Référence des Angioedèmes, CHU de Grenoble, Échirolles, France
| | - Frédéric Dezoteux
- CHU Lille, Service de Dermatologie, Université de Lille, INSERM U1286, Lille Inflammation Translational Research Institute (INFINITE) F-59000, Lille, France
| | | | | | - Claire Bernier
- Plateforme Transversale d'Allergologie, Hôtel-Dieu-CHU de Nantes, Nantes, France
| | - Jean-Luc Perrot
- Service Dermatologie-Allergologie-Oncologie, CHU Nord Saint-Étienne U1059 INSERM, Saint-Priest-en-Jarez, France
| | | | - Marie Paryl
- Laboratoire de Biostatistiques, Épidémiologie, Santé Publique et Innovation Médicale Bespim, CHU De Nîmes, Nîmes, France
| | - Catherine Droitcourt
- Service de Dermatologie, CHU Rennes, Rennes, France; Université Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
| | - Pascal Demoly
- Department of Allergology, University Hospital of Montpellier, Montpellier, France; IDESP UA11 University Montpellier, Montpellier, France
| | - Julien Grosjean
- Département d'Informatique BioMédicale, CHU de Rouen & LIMICS, U1142, Sorbonne Université, Paris, France
| | - Thibault Mura
- Laboratoire de Biostatistiques, Épidémiologie, Santé Publique et Innovation Médicale Bespim, CHU De Nîmes, Nîmes, France
| | - Aurélie Du-Thanh
- Département de Dermatologie, C.H.U de Montpellier, Montpellier, France.
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15
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Larenas-Linnemann D. Biomarkers of Autoimmune Chronic Spontaneous Urticaria. Curr Allergy Asthma Rep 2023; 23:655-664. [PMID: 38064133 DOI: 10.1007/s11882-023-01117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
PURPOSEOF REVIEW Chronic spontaneous urticaria and chronic inducible urticaria (CSU/CindU) are caused by mast cell and basophil activation leading to degranulation and the release of histamine and several other mediators. Three kinds of factors can trigger mast cells in CSU: (1) activation of stimulating receptor(s) on the mast cell membrane, (2) upregulation of certain receptor(s), and (3) intracellular dysregulation in signaling with overexpression of the spleen tyrosine kinase (SYK) or reduced activation of the inhibitory Src homology 2 (SH2)-containing inositol phosphatases (SHIP)-related pathways. In CSU, two major endotypes exist based on the primary receptor activating mechanism: type I hypersensitivity (IgE-mediated, directed against auto-allergens) and type IIb (autoimmune, via IgG autoantibodies directed against IgE or the IgE-receptor). Their treatment responses vary. We discuss in vitro and in vivo biomarkers. RECENT FINDINGS Patients with auto-allergic CSU have clinical characteristics that can distinguish them partly from those with autoimmune CSU. Most importantly, their disease generally presents a less aggressive course, a better response to second generation (up-dosed) antihistamines and a good response to omalizumab, if necessary. Meanwhile, autoimmune CSU/CindU patients fare less well and often need immunosuppressive drugs. Biomarkers that might help endotype CSU/CindU patients and select the most appropriate treatment, dose, and duration, e.g., for autoallergic CSU, high total IgE and IgE against auto-allergens; for autoimmune CSU, low IgE, basopenia, and IgG against autoantigens like thyroid peroxidase and a positive autologous serum skin test (but sometimes also positive in autoallergy). Some biomarkers are easily accessible but of low specificity; others are highly specific but more futuristic.
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Affiliation(s)
- Désirée Larenas-Linnemann
- Centro de Excelencia en Asma y Alergia, Hospital Médica Sur, Puente de Piedra 150, T2-602 Colonia Toriello-Guerra, Delegación Tlalpan, 14050, Mexico City, Mexico.
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16
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Su W, Tian Y, Wei Y, Hao F, Ji J. Key genes and immune infiltration in chronic spontaneous urticaria: a study of bioinformatics and systems biology. Front Immunol 2023; 14:1279139. [PMID: 38045687 PMCID: PMC10693338 DOI: 10.3389/fimmu.2023.1279139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Background Chronic spontaneous urticaria (CSU) is defined by the spontaneous occurrence of wheals and/or angioedema for >6 weeks. The pathogenesis involves skin mast cells, but the complex causes of their activation remain to be characterized in detail. Objectives To explore disease-driving genes and biological pathways in CSU. Methods Two microarray data sets, e.g., GSE57178 and GSE72540, with mRNA information of skin from CSU patients, were downloaded from the Gene Expression Omnibus (GEO) database. An integrated bioinformatics pipeline including identification of differentially expressed genes (DEGs), functional enrichment analysis, protein-protein interaction (PPI) network analysis, co-expression and drug prediction analysis, and immune and stromal cells deconvolution analyses were applied to identify hub genes and key drivers of CSU pathogenesis. Results In total, we identified 92 up-regulated and 7 down-regulated genes in CSU lesions. These were significantly enriched in CSU-related pathways such as TNF, NF-κB, and JAK-STAT signaling. Based on PPI network modeling, four genes, i.e., IL-6, TLR-4, ICAM-1, and PTGS-2, were computationally identified as key pathogenic players in CSU. Immune infiltration analyses indicated that dendritic cells, Th2 cells, mast cells, megakaryocyte-erythroid progenitor, preadipocytes, and M1 macrophages were increased in lesional CSU skin. Conclusion Our results offer new insights on the pathogenesis of CSU and suggest that TNF, NF-κB, JAK-STAT, IL-6, TLR-4, ICAM-1, and PTGS-2 may be candidate targets for novel CSU treatments.
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Affiliation(s)
- Wenxing Su
- Department of Dermatology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Dermatology and Plastic Surgery Center, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Tian
- Department of Dermatology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Yuqian Wei
- Department of Dermatology, Nantong Third People’s Hospital, Nantong, China
| | - Fei Hao
- Dermatology and Plastic Surgery Center, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiang Ji
- Department of Dermatology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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17
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Craffert V, Day C, Peter J. New-onset chronic spontaneous urticaria post-COVID-19 vaccination-South African case series. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100154. [PMID: 37781658 PMCID: PMC10509972 DOI: 10.1016/j.jacig.2023.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 10/03/2023]
Abstract
Background Chronic spontaneous urticaria (CSU) is defined as the spontaneous occurrence of hives, angioedema, or both for more than 6 weeks; several inciting triggers including vaccines have been implicated. Coronavirus disease 2019 (COVID-19) vaccinations have been well tolerated by patients with CSU. However, reports have emerged of CSU triggered by COVID-19 vaccination and this study describes a South African case series. Objective To provide details of the first case series of new-onset CSU post-COVID-19 vaccination in Africa and summarize the global literature of reported cases to date. Methods All patients referred to our Urticaria Center of Excellence in Cape Town from the initiation of the COVID-19 vaccine rollout in South Africa (from February 2021 to August 2022) were reviewed to identify patients who developed new-onset CSU within 12 weeks of receiving a COVID-19 vaccine. Medical history, physical examinations, and laboratory investigations were reviewed. Results More than 20 million adults received COVID-19 vaccinations in South Africa during the study period. Eight patients had new-onset chronic urticaria post-COVID-19 vaccination; 6 of the 8 patients were female, the median age was 41 years (interquartile range [IQR], 38-44), and all had a history of atopy. Only 1 reported COVID-19 infection post vaccination. Chronic urticaria occurred following Pfizer-BioNTech, AstraZeneca, and Janssen Ad26.COV2.S vaccination in 6, 1, and 1 patient, respectively, with a median of 12 days (IQR, 3-38) from vaccination to symptoms onset. The baseline median score for Urticarial Activity Score 7 was 34 (IQR, 29-40), and 5 of the 8 patients (63%) had a total IgE level of more than 43 IU/L. All patients received high-dose antihistamines, with only 3 patients controlled. Conclusions New-onset CSU can rarely be triggered by COVID-19 vaccinations, most commonly mRNA vaccines. COVID-19 vaccine-triggered CSU appears to have a phenotype similar to that triggered by other inciting agents and across populations.
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Affiliation(s)
- Valmy Craffert
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Mowbray, Cape Town, South Africa
| | - Cascia Day
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Mowbray, Cape Town, South Africa
- Division of Allergology and Clinical Immunology, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Jonny Peter
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Mowbray, Cape Town, South Africa
- Division of Allergology and Clinical Immunology, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, Observatory, Cape Town, South Africa
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18
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Cagdas D, Ayasun R, Gulseren D, Sanal O, Tezcan I. Cutaneous Findings in Inborn Errors of Immunity: An Immunologist's Perspective. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3030-3039. [PMID: 37391021 DOI: 10.1016/j.jaip.2023.06.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023]
Abstract
Cutaneous manifestations are common in patients with inborn errors of immunity (IEI)/primary immunodeficiency and could be due to infections, immune dysregulation, or lymphoproliferative/malign diseases. Immunologists accept some as warning signs for underlying IEI. Herein, we include noninfectious/infectious cutaneous manifestations that we come across in rare IEI cases in our clinic and provide a comprehensive literature review. For several skin diseases, the diagnosis is challenging and differential diagnosis is necessary. Detailed disease history and examination play a vital role in reaching a diagnosis, especially if there is a potential underlying IEI. A skin biopsy is sometimes necessary, especially if we need to rule out inflammatory, infectious, lymphoproliferative, and malignant conditions. Specific and immunohistochemical stainings are particularly important when diagnosing granuloma, amyloidosis, malignancies, and infections like human herpes virus-6, human herpes virus-8, human papillomavirus, and orf. Elucidation of mechanisms of IEIs has improved our understanding of their relation to cutaneous findings. In challenging cases, the immunological evaluation may lead the approach when there is a specific primary immunodeficiency diagnosis or at least help to reduce the number of differential diagnoses. Conversely, the response to therapy may provide conclusive evidence for some conditions. This review raises awareness of concomitant lesions and expands the scope of the differential diagnosis of IEI and the spectrum of skin disease therapy by highlighting frequent forms of IEI-associated cutaneous manifestations. The manifestations given here will guide clinicians to plan for alternative use of diverse therapeutics in a multidisciplinary way for skin diseases.
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Affiliation(s)
- Deniz Cagdas
- Department of Pediatrics, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey; Department of Pediatric Immunology, Institute of Child Health, Hacettepe University, Ankara, Turkey; Department of Pediatrics, Division of Immunology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Ruveyda Ayasun
- Depatment of Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY
| | - Duygu Gulseren
- Department of Dermatology, Hacettepe University Medical School, Ankara, Turkey
| | - Ozden Sanal
- Department of Pediatrics, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey; Department of Pediatric Immunology, Institute of Child Health, Hacettepe University, Ankara, Turkey; Department of Pediatrics, Division of Immunology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ilhan Tezcan
- Department of Pediatrics, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey; Department of Pediatric Immunology, Institute of Child Health, Hacettepe University, Ankara, Turkey; Department of Pediatrics, Division of Immunology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Li S, Wu J, Cao N, Wang Q, Zhang Y, Yang T, Miao Y, Pan L, Xiao H, Liu M, Sun C, Yao J, Xiao X. Jingfang granules ameliorate inflammation and immune disorders in mice exposed to low temperature and high humidity by restoring the dysregulation of gut microbiota and fecal metabolites. Biomed Pharmacother 2023; 165:115050. [PMID: 37354813 DOI: 10.1016/j.biopha.2023.115050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023] Open
Abstract
The dramatic changes in global climate on human health have been extremely severe. The immune disorder caused by low temperature and high humidity (LTHH) have become a severe public health issue. Clinically, Jingfang granule (JF) has the effect of dispelling cold and eliminating dampness, and is widely used in the treatment of cold caused by wind and cold, autoimmune diseases, and COVID-19 with cold-dampness stagnating in the lung pattern. Our study aims to elucidate the effect of JF on LTHH-induced immune disorders in mice as well as the underlying mechanisms. In this study, JF increased the spleen index, improved fecal character, repaired the intestinal barrier and alleviated intestinal inflammatory responses. Most importantly, JF ameliorated immune disorder in LTHH mice, which was manifested primarily by the significant increase in gdT, CD8+ Tcm, and CD8+ Tem cells, as well as the decrease in TH1, TH17, CD4+ Tem1, CD4+ Tem2, immature NK, mature NK cells, and M1-like macrophages. Interestingly, the JF treatment not only regulated the gut microbiota by decreasing the abundance of harmful bacteria, as well as up-regulating the abundance of beneficial bacteria, but also ameliorated the metabolic disorders by reversing the levels of fecal metabolites to normality. The results of the correlation analysis demonstrated a significant association among gut microbiota, fecal metabolites and immune cells. In addition, JF inhibited the TLR4/NF-κB/NLRP3 pathway in LTHH mice. In conclusion, our results suggested that JF alleviated inflammation and immune disorders in LTHH mice by restoring gut microbiota and fecal metabolism.
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Affiliation(s)
- Shirong Li
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Jieyi Wu
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Ningning Cao
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Qingguo Wang
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | | | - Tianye Yang
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi 276005, China; Linyi Key Laboratory for Immunopharmacology and Immunotoxicology of Natural Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi 273400, China
| | - Yu Miao
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi 276005, China; Linyi Key Laboratory for Immunopharmacology and Immunotoxicology of Natural Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi 273400, China
| | - Lihong Pan
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi 276005, China; Linyi Key Laboratory for Immunopharmacology and Immunotoxicology of Natural Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi 273400, China
| | - He Xiao
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi 276005, China; Linyi Key Laboratory for Immunopharmacology and Immunotoxicology of Natural Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi 273400, China
| | - Mingfei Liu
- Key Laboratory of Marine Drugs, Chinese Ministry of Education, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
| | - Chenghong Sun
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi 276005, China; Linyi Key Laboratory for Immunopharmacology and Immunotoxicology of Natural Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi 273400, China.
| | - Jingchun Yao
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi 276005, China; Linyi Key Laboratory for Immunopharmacology and Immunotoxicology of Natural Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi 273400, China.
| | - Xuefeng Xiao
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
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20
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Vats V, Makineni P, Hemaida S, Haider A, Subramani S, Kaur N, Butt AN, Scott-Emuakpor R, Zahir M, Mathew M, Iqbal J. Gluten Intolerance and Its Association With Skin Disorders: A Narrative Review. Cureus 2023; 15:e44549. [PMID: 37790051 PMCID: PMC10544948 DOI: 10.7759/cureus.44549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Gluten sensitivity is defined as a chronic intolerance to gluten ingestion in genetically predisposed individuals. The etiology is thought to be immune-mediated and has a variable dermatologic presentation. Celiac disease (CD) is one of the most common forms of gluten intolerance and encompasses a wide range of extra-intestinal pathology, including cutaneous, endocrine, nervous, and hematologic systems. Psoriasis, another long-term inflammatory skin condition, has been linked to significant symptomatic improvement with a gluten-free diet (GFD). Palmoplantar pustulosis (PP), a variant of psoriasis, and aphthous stomatitis, which causes recurrent oral ulcers, have also exhibited beneficial results after the dietary elimination of gluten. In addition to this, dermatitis herpetiformis (DH), another immune-mediated skin disorder, is genetically similar to CD and has, therefore, shown tremendous improvement with a GFD. Another highly prevalent long-term skin condition called atopic dermatitis (AD), however, has revealed inconsistent results with gluten elimination and would require further research in the future to yield concrete results. Hereditary angioedema (HA) has shown an association with gluten intolerance in some patients who had symptomatic benefits with a GFD. Similarly, vitiligo and linear IgA bullous dermatosis have also shown some clinical evidence of reversal with a GFD. On the contrary, rosacea enhances the risk of developing CD. This narrative review emphasizes the potential impact of gluten intolerance on different cutaneous conditions and the potential therapeutic effect of a GFD on various symptomatic manifestations. There is a need for additional clinical and observational trials to further expand on the underlying pathophysiology and provide conclusive and comprehensive recommendations for possible dietary interventions.
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Affiliation(s)
- Vaibhav Vats
- Internal Medicine, Smt. Kashibai Navale Medical College and General Hospital, Mumbai, IND
| | - Pallavi Makineni
- Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | | | - Anum Haider
- Internal Medicine, Bahria University Medical & Dental College, Karachi, PAK
| | | | - Navjot Kaur
- Medicine, Government Medical College, Amritsar, Amritsar, IND
| | - Amna Naveed Butt
- Medicine/Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | - Mohammad Zahir
- Medicine, Ayub Medical College, Abottabad, Abottabad, PAK
| | - Midhun Mathew
- Internal Medicine, Pennsylvania Hospital, Philadelphia, USA
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Zhang JF, Wang YD, Lin P, Li JC, Guo CQ, Zhai JB, Zhang Y. Efficacy and safety of Runzao Zhiyang capsule for chronic urticaria: a systematic review and meta-analysis of randomized controlled trials. Front Pharmacol 2023; 14:1200252. [PMID: 37693898 PMCID: PMC10491456 DOI: 10.3389/fphar.2023.1200252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
Background: Chronic urticaria (CU) is a commonly seen skin disorder featured by recurring wheals, with or without angioedema, lasting for at least 6 weeks. Runzao Zhiyang capsule (RZC) has been widely applied to treat patients with CU. This study is aimed at systematically evaluating the efficacy and safety of RZC in treating CU. Materials and Methods: Randomized controlled trials (RCTs) of RZC on treating CU from Chinese and English databases were searched. Data were collected by two independent researchers. The Cochrane Collaboration tool was adopted for evaluating the risk of bias. The meta-analysis was performed with Review Manager 5.3 software. Sensitivity analysis and publication bias assessment were conducted by Stata 14.0 software. Results: Totally 27 studies were included in the analysis, involving 2,703 patients. The pooled results showed that compared with second-generation H1-antihistamines (sgAHs) therapy alone, RZC combined with sgAHs is more effective in improving the total effective rate (RR = 1.32, 95% CI: 1.25 to 1.39, p < 0.00001), the quality of life measured by Dermatology Life Quality Index (DLQI) (MD = -2.63, 95% CI: -3.68 to -1.58, p < 0.00001) and the serum IFN-γ level (SMD = 3.10, 95% CI: 1.58 to 4.62, p < 0.0001), and reducing the recurrence rate (RR = 0.39, 95% CI: 0.27 to 0.55, p < 0.00001), the serum total IgE level (SMD = -2.44, 95% CI: -3.51 to -1.38, p < 0.00001), the serum IL-4 level (SMD = -2.96, 95% CI: -4.10 to -1.83, p < 0.00001), and the incidence of adverse events including dizziness, fatigue, dry mouth, and constipation (RR = 0.53, 95% CI: 0.33 to 0.85, p = 0.009; RR = 0.46, 95% CI: 0.26 to 0.84, p = 0.01; RR = 0.57, 95% CI: 0.34 to 0.95, p = 0.03; RR = 0.24, 95% CI: 0.07 to 0.85, p = 0.03). Conclusion: The current evidence indicates that RZC may be an efficient therapeutic regimen in patients with CU. Nevertheless, owing to the suboptimal quality of the included studies, more large-scale, well-designed RCTs are required to verify the obtained findings. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/; Identifier: CRD42022313177.
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Affiliation(s)
- Jian-Feng Zhang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ying-Dong Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Peng Lin
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jun-Chen Li
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chen-Qi Guo
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jing-Bo Zhai
- School of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yu Zhang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
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22
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Kuna M, Štefanović M, Ladika Davidović B, Mandušić N, Birkić Belanović I, Lugović-Mihić L. Chronic Urticaria Biomarkers IL-6, ESR and CRP in Correlation with Disease Severity and Patient Quality of Life-A Pilot Study. Biomedicines 2023; 11:2232. [PMID: 37626727 PMCID: PMC10452525 DOI: 10.3390/biomedicines11082232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: To assess the relationship between serum interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values and disease severity in patients with chronic spontaneous urticaria (CSU) and to examine which of these serum biomarkers better indicates disease severity. (2) Methods: Our pilot study included 20 patients with CSU who filled out questionnaires concerning disease severity and quality of life (the Urticaria Activity Score summed over 7 days [UAS7], the once-daily Urticaria Activity Score [UAS], the Urticaria Control Test [UCT], and the Dermatology Life Quality Index [DLQI]). Blood samples were taken to measure IL-6, ESR and CRP. (3) Results: ESR significantly correlated with the UAS7 (linear and moderate correlation; r = 0.496; p = 0.026), while CRP did not correlate with disease severity. IL-6 correlated with the once-daily UAS (r = 0.472; p = 0.036) and DLQI (r = 0.504; p = 0.023) (linear and moderate correlation) but not the UAS7 or UCT. (4) Conclusions: IL-6 was a better indicator of the once-daily UAS and DLQI, while ESR was a better indicator of the UAS7 (there was no correlation between IL-6, CRP and ESR parameters). Although our results are promising, this study should be conducted with a larger number of CSU patients.
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Affiliation(s)
- Matea Kuna
- Department of Dermatovenereology, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia; (N.M.); (I.B.B.); (L.L.-M.)
| | - Mario Štefanović
- Department of Clinical Chemistry, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia;
| | - Blaženka Ladika Davidović
- Department of Oncology and Nuclear Medicine, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia;
| | - Nikolina Mandušić
- Department of Dermatovenereology, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia; (N.M.); (I.B.B.); (L.L.-M.)
| | - Ines Birkić Belanović
- Department of Dermatovenereology, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia; (N.M.); (I.B.B.); (L.L.-M.)
| | - Liborija Lugović-Mihić
- Department of Dermatovenereology, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia; (N.M.); (I.B.B.); (L.L.-M.)
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23
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Asero R, Ferrer M, Kocaturk E, Maurer M. Chronic Spontaneous Urticaria: The Role and Relevance of Autoreactivity, Autoimmunity, and Autoallergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2302-2308. [PMID: 36868473 DOI: 10.1016/j.jaip.2023.02.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
Chronic spontaneous urticaria (CSU) is a frequent and often severely disabling disease. A large number of studies were performed during the last 2 decades to clarify its pathogenesis. These studies shed light on the underlying autoimmune mechanisms of CSU pathogenesis and have led us to understand that different mechanisms may exist and, sometimes, coexist behind the same clinical presentation. The present article reviews the meaning of the terms autoreactivity, autoimmunity, and autoallergy, which have been variably used over the years to define different endotypes of the disease. Furthermore, we discuss the methods potentially able to lead us to the correct classification of CSU patients.
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Affiliation(s)
- Riccardo Asero
- Allergy Department, San Carlo Clinic, Paderno Dugnano, Milan, Italy.
| | - Marta Ferrer
- Department of Allergy, University Clinic of Navarra, Pamplona, Spain; Network of Inlammatory Diseases (REI)-RD21/0002/0028, Madrid, Spain
| | - Emek Kocaturk
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey; Institute of Allergology, Charitè, Medical University of Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charitè, Medical University of Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
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24
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Karstarli Bakay OS, Demir B, Cicek D, Erol D, Aşçı Toraman Z, Gural Y, Maurer M. In chronic spontaneous urticaria, IgE and C-reactive protein are linked to distinct microRNAs and interleukin-31. Clin Transl Allergy 2023; 13:e12290. [PMID: 37632245 PMCID: PMC10405150 DOI: 10.1002/clt2.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a common and disabling disease. Assessments of IgE and C-reactive protein (CRP) are recommended in the diagnostic work-up, but the role and clinical relevance of these biomarkers are not well characterized. Moreover, it remains unknown if elevated levels of IgE or CRP are linked to CSU microRNA (miRNA) signatures or interleukin 31 (IL-31). METHODS We measured IgE and CRP serum levels in 47 CSU patients (and 45 healthy controls) and determined CSU disease activity using the urticaria activity score (UAS7). Expression levels of miR-155 and miR-221 were assessed by RT-PCR, and IL-31 levels were determined by ELISA. RESULTS Total IgE and CRP levels were independently increased in CSU patients. IgE and CRP levels were highest and lowest in patients with high and mild disease activity. IgE levels correlated with miR-155 levels, whereas CRP levels correlated with miR-221 levels. miR-155 and miR-221 were significantly overexpressed in CSU patients. ROC analyses linked miRNA-155 and CSU with a sensitivity of 79% and specificity of 87%, and miRNA-221 and CSU with a sensitivity of 75% and specificity of 91%. High CRP and miR-221 expression levels were linked to elevated levels of IgG anti-TPO and IL-31. CONCLUSION IgE and CRP are useful biomarkers for disease activity in CSU, with distinct miRNA profiles. High CRP and miR-221 levels may point to autoimmune CSU and a role for IL-31.
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Affiliation(s)
| | - Betül Demir
- Department of DermatologyFirat University Faculty of MedicineElazigTurkey
| | - Demet Cicek
- Department of DermatologyFirat University Faculty of MedicineElazigTurkey
| | - Deniz Erol
- Department of Medical GeneticsFirat University Faculty of MedicineElazigTurkey
| | - Zulal Aşçı Toraman
- Department of MicrobiologyFirat University Faculty of MedicineElazigTurkey
| | - Yunus Gural
- Division of StatisticsFirat University Faculty of ScienceElazigTurkey
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE)Institute of AllergologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology, and ImmunologyBerlinGermany
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25
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Kristjansson RP, Oskarsson GR, Skuladottir A, Oddsson A, Rognvaldsson S, Sveinbjornsson G, Lund SH, Jensson BO, Styrmisdottir EL, Halldorsson GH, Ferkingstad E, Eldjarn GH, Beyter D, Kristmundsdottir S, Juliusson K, Fridriksdottir R, Arnadottir GA, Katrinardottir H, Snorradottir MH, Tragante V, Stefansdottir L, Ivarsdottir EV, Bjornsdottir G, Halldorsson BV, Thorleifsson G, Ludviksson BR, Onundarson PT, Saevarsdottir S, Melsted P, Norddahl GL, Bjornsdottir US, Olafsdottir T, Gudbjartsson DF, Thorsteinsdottir U, Jonsdottir I, Sulem P, Stefansson K. Sequence variant affects GCSAML splicing, mast cell specific proteins, and risk of urticaria. Commun Biol 2023; 6:703. [PMID: 37430141 DOI: 10.1038/s42003-023-05079-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/28/2023] [Indexed: 07/12/2023] Open
Abstract
Urticaria is a skin disorder characterized by outbreaks of raised pruritic wheals. In order to identify sequence variants associated with urticaria, we performed a meta-analysis of genome-wide association studies for urticaria with a total of 40,694 cases and 1,230,001 controls from Iceland, the UK, Finland, and Japan. We also performed transcriptome- and proteome-wide analyses in Iceland and the UK. We found nine sequence variants at nine loci associating with urticaria. The variants are at genes participating in type 2 immune responses and/or mast cell biology (CBLB, FCER1A, GCSAML, STAT6, TPSD1, ZFPM1), the innate immunity (C4), and NF-κB signaling. The most significant association was observed for the splice-donor variant rs56043070[A] (hg38: chr1:247556467) in GCSAML (MAF = 6.6%, OR = 1.24 (95%CI: 1.20-1.28), P-value = 3.6 × 10-44). We assessed the effects of the variants on transcripts, and levels of proteins relevant to urticaria pathophysiology. Our results emphasize the role of type 2 immune response and mast cell activation in the pathogenesis of urticaria. Our findings may point to an IgE-independent urticaria pathway that could help address unmet clinical need.
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Affiliation(s)
| | - Gudjon R Oskarsson
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | | | | | | | | | | | | | | | | | | | - Snædis Kristmundsdottir
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
| | | | | | | | | | | | | | | | - Erna V Ivarsdottir
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Bjarni V Halldorsson
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
| | | | - Bjorn R Ludviksson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Immunology, Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Pall T Onundarson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Laboratory Hematology, Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Saedis Saevarsdottir
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Department of Medicine, Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Pall Melsted
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Unnur S Bjornsdottir
- Department of Medicine, Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
- The Medical Center Mjodd, Reykjavik, Iceland
| | - Thorunn Olafsdottir
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Daniel F Gudbjartsson
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Unnur Thorsteinsdottir
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Ingileif Jonsdottir
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Kari Stefansson
- deCODE genetics/Amgen Inc., Reykjavik, Iceland.
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
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26
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Koshak EA, Atwah AF, Ahmad HMY. IgG food hypersensitivity: A potential hidden precipitant for chronic spontaneous urticaria A case report. Allergol Immunopathol (Madr) 2023; 51:148-150. [PMID: 37422791 DOI: 10.15586/aei.v51i4.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/12/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND While the link between foods and chronic spontaneous urticaria (CSU) is controversial, many immunological mechanisms have been proposed to establish a causal relationship. OBJECTIVE To explore the potential benefit of avoiding immunoglobulin G (IgG)-mediated food hypersensitivity as a triggering factor in a case with CSU. HISTORY The patient is a 50-year-old woman who complained of CSU for 1 and half year, which responded partially and temporarily to antihistamine medications. Of interest, it started 6 months after she followed an oat-rich diet. Her Urticaria Activity Score 7 was 23 out of 40. RESULTS Specific immunoglobulin E responses to common food and inhalant allergens were negative. A food-specific IgG antibody test was conducted, and it was mainly elevated for chicken eggs, rye, sweet pepper, gluten, garlic, wheat, and pineapple. Avoiding these foods had a curative effect on the CSU over a 2-month period. CONCLUSION To the best of our knowledge, this is the first case report of symptoms of CSU that resolved after identifying and avoiding food items with IgG antibodies. Furthermore, well-controlled studies are advocated to verify the potential role of IgG food hypersensitivity in the pathogenesis of CSU.
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Affiliation(s)
- Emad Abdulkader Koshak
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ali Fahad Atwah
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
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27
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Armstrong AW, Soong W, Bernstein JA. Chronic Spontaneous Urticaria: How to Measure It and the Need to Define Treatment Success. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00955-7. [PMID: 37354293 PMCID: PMC10366057 DOI: 10.1007/s13555-023-00955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023] Open
Abstract
Chronic spontaneous urticaria (CSU) is a complex skin disease characterized by the spontaneous appearance of wheals, angioedema, or both, for more than 6 weeks. Many patients experience a relapsing-remitting disease course for years. Owing to the unpredictability of wheal recurrence and the severity of pruritis, patients suffer considerable impairment in their quality of life. Physicians face multiple challenges, not least of which is a lack of clear guidance on what constitutes "treatment success". There is a lack of awareness of which measures should be used to best assess the various aspects of CSU, including disease activity, disease control, and quality of life-which themselves each comprise multiple components-and how to apply the results of each score to treatment decision-making. Although the overarching aim of treatment is for patients to be completely free of signs and symptoms of CSU, a more realistic definition of "treatment success" is needed to guide ongoing, long-term disease management for each individual patient. In this review, we consider what lessons can be learned from the current evidence base to provide further direction toward a universal definition of "treatment success".
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Affiliation(s)
- April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Weily Soong
- Alabama Allergy and Asthma Center and Clinical Research Center of Alabama, Birmingham, AL, USA
| | - Jonathan A Bernstein
- Division of Immunology/Allergy Section, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH, USA
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28
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Ćesić D, Lugović Mihić L, Ozretić P, Lojkić I, Buljan M, Šitum M, Zovak M, Vidović D, Mijić A, Galić N, Tambić Andrašević A. Association of Gut Lachnospiraceae and Chronic Spontaneous Urticaria. Life (Basel) 2023; 13:1280. [PMID: 37374063 DOI: 10.3390/life13061280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Chronic spontaneous urticaria (CSU) has been linked to the dysbiosis of the gut microbiota. Furthermore, various studies have highlighted the anti-inflammatory properties of short-chain fatty acids (SCFAs), whose production is primarily regulated by the gut microbiota. However, only a few studies have investigated the role of major SCFA producers, such as Lachnospiraceae, in skin inflammatory diseases. (2) Goal: This study aimed to compare the abundance of Lachnospiraceae between CSU patients and healthy controls (HCs). (3) Material and methods: In this case-control study, 16S rRNA sequencing was performed to compare the composition of the gut microbiome between 22 CSU patients and 23 HCs. (4) Results: Beta-diversity revealed significant clustering (p < 0.05) between the CSU patients and HCs. Alpha diversity in the CSU group was significantly decreased according to the Evenness index (p < 0.05). The linear discriminant analysis effect size (LEfSe) identified the significant depletion of the Lachnospiraceae family in CSU patients. (5) Conclusion: Our study revealed the dysbiosis of the gut microbiota in CSU patients, including decreased levels of Lachnospiraceae members, responsible for SCFA production, suggesting that SCFAs may contribute to immune dysfunction in the pathogenesis of CSU. We speculate that the modulation of SCFAs could serve as a prospective additional option in CSU treatment.
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Affiliation(s)
- Diana Ćesić
- Department of Dermatology and Venereology, Medikol Clinic, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Liborija Lugović Mihić
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Dermatology and Venereology, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - Petar Ozretić
- Laboratory for Hereditary Cancer, Division of Molecular Medicine, Ruđer Bošković Institute, 10000 Zagreb, Croatia
| | - Ivana Lojkić
- Croatian Veterinary Institute, 10000 Zagreb, Croatia
| | - Marija Buljan
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Dermatology and Venereology, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - Mirna Šitum
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Dermatology and Venereology, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - Mario Zovak
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Surgery, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - Dinko Vidović
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Surgery, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - August Mijić
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Surgery, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - Nada Galić
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Arjana Tambić Andrašević
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Clinical Microbiology, University Hospital for Infectious Diseases, 10000 Zagreb, Croatia
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29
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Ćesić D, Lugović Mihić L, Ozretić P, Lojkić I, Buljan M, Šitum M, Zovak M, Vidović D, Mijić A, Galić N, Tambić Andrašević A. Association of Gut Lachnospiraceae and Chronic Spontaneous Urticaria. Life (Basel) 2023; 13:1280. [DOI: https:/doi.org/10.3390/life13061280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
(1) Background: Chronic spontaneous urticaria (CSU) has been linked to the dysbiosis of the gut microbiota. Furthermore, various studies have highlighted the anti-inflammatory properties of short-chain fatty acids (SCFAs), whose production is primarily regulated by the gut microbiota. However, only a few studies have investigated the role of major SCFA producers, such as Lachnospiraceae, in skin inflammatory diseases. (2) Goal: This study aimed to compare the abundance of Lachnospiraceae between CSU patients and healthy controls (HCs). (3) Material and methods: In this case–control study, 16S rRNA sequencing was performed to compare the composition of the gut microbiome between 22 CSU patients and 23 HCs. (4) Results: Beta-diversity revealed significant clustering (p < 0.05) between the CSU patients and HCs. Alpha diversity in the CSU group was significantly decreased according to the Evenness index (p < 0.05). The linear discriminant analysis effect size (LEfSe) identified the significant depletion of the Lachnospiraceae family in CSU patients. (5) Conclusion: Our study revealed the dysbiosis of the gut microbiota in CSU patients, including decreased levels of Lachnospiraceae members, responsible for SCFA production, suggesting that SCFAs may contribute to immune dysfunction in the pathogenesis of CSU. We speculate that the modulation of SCFAs could serve as a prospective additional option in CSU treatment.
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Affiliation(s)
- Diana Ćesić
- Department of Dermatology and Venereology, Medikol Clinic, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Liborija Lugović Mihić
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Dermatology and Venereology, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - Petar Ozretić
- Laboratory for Hereditary Cancer, Division of Molecular Medicine, Ruđer Bošković Institute, 10000 Zagreb, Croatia
| | - Ivana Lojkić
- Croatian Veterinary Institute, 10000 Zagreb, Croatia
| | - Marija Buljan
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Dermatology and Venereology, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - Mirna Šitum
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Dermatology and Venereology, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - Mario Zovak
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Surgery, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - Dinko Vidović
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Surgery, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - August Mijić
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Surgery, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
| | - Nada Galić
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Arjana Tambić Andrašević
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Clinical Microbiology, University Hospital for Infectious Diseases, 10000 Zagreb, Croatia
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Ding Y, Dang B, Zhang Y, Hu S, Wang Y, Zhao C, Zhang T, Gao Z. Paeonol attenuates Substance P-induced urticaria by inhibiting Src kinase phosphorylation in mast cells. Cell Immunol 2023; 388-389:104728. [PMID: 37224634 DOI: 10.1016/j.cellimm.2023.104728] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Treatment of chronic urticaria is challenging, the discovery of effective therapeutic drugs is urgently in demand. PURPOSE To study the effect and mechanism of Paeonol targeting mast cells and its therapeutic effect on chronic urticaria. STUDY DESIGN We developed a chronic urticaria model in vivo and mast cell model in vitro examined the effect of Paeonol in the treatment of chronic urticaria and its mechanism of action in mast cells. METHOD The anti-anaphylactoid effect of Paeonol was evaluated in PCA and systemic anaphylaxis models. The treatment role of Paeonol was studied in urticaria model. The release of cytokines and chemokines was measured using enzyme immunoassay kits. Western blot analysis was conducted to investigate phosphorylation of Src, PI3K, and PLC. In vitro kinase assays were conducted to investigate the kinase activity of Lyn, PLC, PI3K and Src. RESULTS In our study, Paeonol was able to attenuate evans blue leakage, serum histamine and chemokine release in a passive skin allergic reaction model. Simultaneously, Paeonol inhibited vasodilation and mast cell degranulation in C57BL/6 mice. Further research found that Paeonol alleviated symptoms such as erythema and rash in the Substance P-induced urticaria model, this is accompanied by inhibiting the release of related inflammatory factors. Validation experiments on mast cells in vitro found that Paeonol inhibited the activation of Src-PI3K/Lyn-PLC-NF-κB signaling pathway by crosslinking with Src kinase. Moreover, calcium influx, mast cell degranulation, cytokines generation and chemotaxis were reduced in LAD2 cells. Molecular docking experiments revealed that Paeonol is a specific antagonist targeting Src kinase in the treatment of skin diseases such as urticaria. CONCLUSION Paeonol, a herb-derived phenolic compound, can provide drug candidate for developing new drug in treatment of skin disease such as urticaria. SIGNIFICANCE STATEMENT In this study, we primarily examined the effect of Paeonol in the treatment of chronic urticaria and its mechanism of action in mast cells. Interestingly, Paeonol was found to regulate Src kinase activity downstream of MRGPRX2 triggered signaling cascade in mast cells. Therefore, this plant-derived phenolic compound may provide a therapeutic option for the treatment of chronic urticaria.
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Affiliation(s)
- Yuanyuan Ding
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Baowen Dang
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Yonghui Zhang
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Shiting Hu
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Yuejin Wang
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Chenrui Zhao
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Tao Zhang
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Zijun Gao
- Department of Anesthesiology, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, China.
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Chang D, Hammer C, Holweg CTJ, Selvaraj S, Rathore N, McCarthy MI, Yaspan BL, Choy DF. A genome-wide association study of chronic spontaneous urticaria risk and heterogeneity. J Allergy Clin Immunol 2023; 151:1351-1356. [PMID: 36343773 DOI: 10.1016/j.jaci.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a dermatologic condition characterized by spontaneous, pruritic hives and/or angioedema that persists for 6 weeks or longer with no identifiable trigger. Antihistamines and second-line therapies such as omalizumab are effective for some CSU patients, but others remain symptomatic, with significant impact on quality of life. This variable response to treatment and autoantibody levels across patients highlight clinically heterogeneous subgroups. OBJECTIVE We aimed to highlight pathways involved in CSU by investigating the genetics of CSU risk and subgroups. METHODS We performed a genome-wide association study (GWAS) of 679 CSU patients and 4446 controls and a GWAS of chronic urticaria (CU)-index, which measures IgG autoantibodies levels, by comparing 447 CU index-low to 183 CU index-high patients. We also tested whether polygenic scores for autoimmune-related disorders were associated with CSU risk and CU index. RESULTS We identified 2 loci significantly associated with disease risk. The strongest association mapped to position 56 of HLA-DQA1 (P = 1.69 × 10-9), where the arginine residue was associated with increased risk (odds ratio = 1.64). The second association signal colocalized with expression-quantitative trait loci for ITPKB in whole blood (Pcolocalization = .997). The arginine residue at position 56 of HLA-DQA1 was also associated with increased risk of CU index-high (P = 6.15 × 10-5, odds ratio = 1.86), while the ITKPB association was not (P = .64). Polygenic scores for 3 autoimmune-related disorders (hypothyroidism, type 1 diabetes, and vitiligo) were associated with CSU risk and CU index (P < 2.34 × 10-3, odds ratio > 1.72). CONCLUSION A GWAS of CSU identified 2 genome-wide significant loci, highlighting the shared genetics between CU index and autoimmune disorders.
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Affiliation(s)
- Diana Chang
- Department of Human Genetics, Genentech Inc, South San Francisco, Calif.
| | - Christian Hammer
- Department of Human Genetics, Genentech Inc, South San Francisco, Calif; Department of Cancer Immunology, Genentech Inc, South San Francisco, Calif
| | | | - Suresh Selvaraj
- Department of Biosample and Repository Management, Genentech Inc, South San Francisco, Calif
| | - Nisha Rathore
- Biomarker Discovery OMNI, Genentech Inc, South San Francisco, Calif
| | - Mark I McCarthy
- Department of Human Genetics, Genentech Inc, South San Francisco, Calif
| | - Brian L Yaspan
- Department of Human Genetics, Genentech Inc, South San Francisco, Calif
| | - David F Choy
- Biomarker Discovery OMNI, Genentech Inc, South San Francisco, Calif
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Brancaccio R, Murdaca G, Casella R, Loverre T, Bonzano L, Nettis E, Gangemi S. miRNAs' Cross-Involvement in Skin Allergies: A New Horizon for the Pathogenesis, Diagnosis and Therapy of Atopic Dermatitis, Allergic Contact Dermatitis and Chronic Spontaneous Urticaria. Biomedicines 2023; 11:biomedicines11051266. [PMID: 37238937 DOI: 10.3390/biomedicines11051266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Skin inflammation is a common underlying feature of atopic dermatitis, allergic contact dermatitis and chronic spontaneous urticaria. The pathogenetic mechanisms have not been fully elucidated. The purpose of this study was to examine whether miRNA, by regulating inflammatory mechanisms through the modulation of innate and adaptive immune responses, could play a major role in the pathogenesis of these skin conditions. We conducted a narrative review using the Pubmed and Embase scientific databases and search engines to find the most relevant miRNAs related to the pathophysiology, severity and prognosis of skin conditions. The studies show that miRNAs are involved in the pathogenesis and regulation of atopic dermatitis and can reveal an atopic predisposition or indicate disease severity. In chronic spontaneous urticaria, different miRNAs which are over-expressed during urticaria exacerbations not only play a role in the possible response to therapy or remission, but also serve as a marker of chronic autoimmune urticaria and indicate associations with other autoimmune diseases. In allergic contact dermatitis, miRNAs are upregulated in inflammatory lesions and expressed during the sensitization phase of allergic response. Several miRNAs have been identified as potential biomarkers of these chronic skin conditions, but they are also possible therapeutic targets.
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Affiliation(s)
- Raffaele Brancaccio
- Dermatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio nell'Emilia, Italy
| | - Giuseppe Murdaca
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
- Department of Internal Medicine, Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Rossella Casella
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico di Bari, 70124 Bari, Italy
| | - Teresa Loverre
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico di Bari, 70124 Bari, Italy
| | - Laura Bonzano
- Dermatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio nell'Emilia, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico di Bari, 70124 Bari, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
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Koç Yıldırım S, Erbağcı E, Hapa A. Omalizumab treatment in combination with any other biologics: Is it really a safe duo? Australas J Dermatol 2023; 64:229-233. [PMID: 36866918 DOI: 10.1111/ajd.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a mast cell-mediated disease, which is sometimes associated with various inflammatory disorders. Omalizumab is a commonly used biological agent, which is a recombinant, humanized, monoclonal antibody against human immunoglobulin E. However, there are only few reports about the combination of omalizumab for CSU with any other biologics for accompanying inflammatory diseases in the literature. The aim of this study was to evaluate the patients whose treatment of omalizumab for CSU were combined with any other biologics for associated inflammatory disorders and to describe whether these combinations might have any safety concerns. METHODS We conducted a retrospective cohort study of adult patients with CSU treated with omalizumab concurrently using another biological agent for their other dermatological conditions. RESULTS Thirty-one patients, 19 women and 12 men, were evaluated. The mean age was 45.13 years. The median duration of omalizumab was 11 months. Biological agents which patients were treated other than omalizumab were as follows: adalimumab biosimilar (n = 3), ustekinumab (n = 4), secukinumab (n = 17) and ixekizumab (n = 7). The median duration of concurrent use of omalizumab and other biologics was 8 months. None of the drug combinations was stopped because of side effects. CONCLUSION This observational study demonstrated that omalizumab treatment for CSU in combination with any other biological agents for dermatological disorders appeared to be well tolerated without any major safety concerns.
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Affiliation(s)
- Sema Koç Yıldırım
- Department of Dermatology and Venereology, Uşak University Faculty of Medicine, Uşak, Turkey
| | - Ece Erbağcı
- Department of Dermatology and Venereology, Uşak University Faculty of Medicine, Uşak, Turkey
| | - Aslı Hapa
- Department of Dermatology and Venereology, Buca Seyfi Demirsoy Training and Research Hospital, İzmir, Turkey
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Ovarian yolk sac tumor in a premenarchal girl. Wien Med Wochenschr 2023; 173:70-73. [PMID: 36637654 DOI: 10.1007/s10354-022-00996-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/25/2022] [Indexed: 01/14/2023]
Abstract
Yolk sac tumors are highly malignant and commonly affect the ovaries, with a median age of occurrence of 23 years. We describe the case of an ovarian yolk sac tumor in a 12-year-old premenarchal girl suffering from Hashimoto's thyroiditis and chronic spontaneous urticaria, which presented as a rapidly growing solid cystic formation in the hypogastrium with an extreme increase in alpha fetoprotein (52,778 mg/ml). After ultrasound and MRI imaging, fertility-sparing staging surgery was performed, and the diagnosis of an ovarian yolk sac tumor with positive malignant cells in ascites was confirmed. The specificity of this case is the tumor classification into stage IC3 according to the FIGO and stage III according to the Children's Oncology Group criteria. The postoperative course was complicated by a pelvic abscess and a subcutaneous suture rejection reaction. Our case may incite further research on the relationship between autoimmunity and yolk sac tumors.
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Wang M, Zhao L, Wang K, Qin Y, Jin J, Wang D, Yan H, You C. Changes of Gut Microbiome in Adolescent Patients with Chronic Spontaneous Urticaria After Omalizumab Treatment. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2023; 16:345-357. [PMID: 36762258 PMCID: PMC9907007 DOI: 10.2147/ccid.s393406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
Purpose Omalizumab is a humanized anti-immunoglobulin (Ig) E monoclonal antibody that is effective in treating some patients with chronic spontaneous urticaria (CSU) who do not respond to antihistamines. Gut microbiome plays a role in the pathogenesis of allergies and autoimmune diseases. Here, we investigated differences in the gut microbiome of adolescent CSU patients before and after omalizumab treatment, which has not been previously reported. Patients and Methods Ten adolescent CSU patients were given 300 mg omalizumab subcutaneously in three treatments at 4-week intervals. Urticaria Activity Score (UAS7) was applied to evaluate the efficacy of each omalizumab treatment during follow-up. Fecal samples were collected before and 12 weeks after the first treatment. Total DNA of the gut microbiota in all fecal samples were extracted. The 16S rRNA gene-targeted sequencing technology was used for the analysis of the diversity and distribution of gut microbiome, followed by bioinformatics analysis. Results UAS7 scores decreased significantly after each treatment compared with the baseline (all P < 0.0001). There were five well-controlled responders and five non-responders after three treatment sessions of omalizumab. The dominant bacteria phyla in all fecal samples were Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria. Alpha diversity analysis showed no significant difference before and after treatment (P > 0.05), whereas beta diversity analysis revealed a significant difference in the bacterial abundance before and after treatment (P < 0.01). The relative abundance of Alphaproteobacteria and Betaproteobacteria at the class level and Burkholderia, Rhodococcus, and Sphingomonas at the genus level decreased significantly after treatment (linear discriminant analysis > 4, P < 0.05). The functional prediction results showed that the dioxin and xylene degradation pathways were more abundant before treatment. Conclusion Omalizumab is effective in treating CSU and the abundance of Alphaproteobacteria and Betaproteobacteria was reduced after treatment, which may help improve the treatment outcomes in adolescent CSU patients.
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Affiliation(s)
- Mei Wang
- Department of Dermatology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, People’s Republic of China
| | - Leran Zhao
- Department of Dermatology and Venereology, The General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Kun Wang
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
| | - Yongzhang Qin
- Department of Endocrinology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
| | - Jingji Jin
- Department of Dermatology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, People’s Republic of China
| | - Dong Wang
- Department of Dermatology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, People’s Republic of China
| | - Huimin Yan
- Department of Dermatology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, People’s Republic of China
| | - Cong You
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China,Correspondence: Cong You, Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China, Tel +8615979766532, Email
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36
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Consecutive injections of low-dose interleukin-2 improve symptoms and disease control in patients with chronic spontaneous urticaria. Clin Immunol 2023; 247:109247. [PMID: 36724835 DOI: 10.1016/j.clim.2023.109247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/30/2023]
Abstract
PURPOSE To describe the effectiveness and tolerability of low-dose interleukin (IL)-2 in treating patients with chronic spontaneous urticaria (CSU) refractory to H1-antihistamines. METHODS This retrospective study included CSU patients who received treatment with at least one cycle of IL-2, injected intramuscularly at a dose of 1.0 million international units daily for 7 consecutive days, after failing treatment with H1-antihistamines. Patients were followed up for ≥12 weeks. RESULTS Of the 15 patients, 7 (46.7%) and 11 (73.3%) achieved complete response at Week 2 and Week 12, respectively. The mean change of urticaria control test (UCT) and weekly urticaria activity score (UAS7) from baseline was 6.6 (95% CI, 4.2 to 8.9) and - 16.9 (95% CI, -24.0 to -9.8), respectively, at Week 12. Local injection-site reactions were the most common adverse events. No serious adverse events were reported. CONCLUSION Low-dose IL-2 treatment improves symptoms and disease control for CSU patients refractory to H1-antihistamines.
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Kaplan A, Lebwohl M, Giménez-Arnau AM, Hide M, Armstrong AW, Maurer M. Chronic spontaneous urticaria: Focus on pathophysiology to unlock treatment advances. Allergy 2023; 78:389-401. [PMID: 36448493 DOI: 10.1111/all.15603] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
Abstract
Chronic spontaneous urticaria (CSU) is a debilitating skin disease characterized by intensely itchy wheals, angioedema, or both. Symptoms recur spontaneously, on a near-daily basis, over >6 weeks; many patients experience flare-ups over several years and, consequently, reduced quality of life. Differences between the inflammatory profiles of the skin of CSU patients (wheals and nonlesional sites) and healthy controls indicate that key drivers such as mast cells, eosinophils, and basophils interact, release vasoactive mediators, and prime the skin, leaving patients predisposed to symptoms. Many cytokines and chemokines involved in these inflammatory networks and their corresponding intracellular signaling cascades have been identified. These insights informed the development of therapies such as omalizumab, dupilumab, and Bruton's tyrosine kinase (BTK) inhibitors, marking a renewed focus on pathogenesis in CSU clinical research. Despite progress, current therapies provide symptomatic control but do not appear to redress the inflammatory balance in the skin permanently. A deeper understanding of CSU pathogenesis will permit a more targeted approach to developing novel treatments with curative intent. Here, we review what is known about the pathogenesis of CSU and consider how this can be used to identify rational targets to improve patient care further.
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Affiliation(s)
- Allen Kaplan
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Institut Mar D'Investigacions Mediques, Universitat Autònoma and Universitat Pompeu Fabra, Barcelona, Spain
| | - Michihiro Hide
- Department of Dermatology, Hiroshima Citizens Hospital and Department of Dermatology, Hiroshima University, Hiroshima, Japan
| | - April W Armstrong
- Department of Dermatology, University of Southern California, Los Angeles, California, USA
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
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Prevalence of Autoimmune and Autoinflammatory Diseases in Chronic Urticaria: Pathogenetic, Diagnostic and Therapeutic Implications. Biomedicines 2023; 11:biomedicines11020410. [PMID: 36830946 PMCID: PMC9953398 DOI: 10.3390/biomedicines11020410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open
Abstract
Chronic spontaneous urticaria (CSU) is defined as the almost daily occurrence of widespread wheals, angioedema, or both, for more than 6 weeks. It affects 1-2% of the general population, with a higher prevalence in female patients, and is more frequent patients over 20 years of age. More than half of all cases of chronic idiopathic urticaria are thought to occur due to an autoimmune mechanism, specifically the production of autoantibodies against the high-affinity immunoglobulin E (IgE) receptor (FcεRI). The quality of life in these patients is often greatly compromised, also due to the onset of comorbidities represented by other autoimmune diseases, such as thyroid disease, rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, celiac disease, and type 1 diabetes, among others. This review aimed to analyze the close correlation between CSU and some autoimmune and autoinflammatory diseases, in order to encourage a multidisciplinary and multimorbid approach to the patient affected by CSU, which allows not only control of the natural course of the disease, but also any associated comorbidities.
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Zagami M, Klepper E, Wienecke E, Andrzejewski M, Sikder A, Ahmed A, Robinson H. A review of psychocutaneous disorders from a psychotherapeutic perspective—Toolkit for the dermatologist. SKIN HEALTH AND DISEASE 2023. [PMID: 37538328 PMCID: PMC10395638 DOI: 10.1002/ski2.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction The study of psychocutaneous disorders requires a multidisciplinary approach. It is of paramount importance that dermatologists understand the psychiatric premise for these disorders. Mental health professionals can also benefit from a better understanding of the dermatologic manifestations of psychiatric disorders they may encounter in their practice. Aim The aim of this study is to elevate the level of understanding regarding psychotherapeutic treatment of psychocutaneous disorders. Methods We performed a literature review using the major databases. Four researchers reviewed English, full text, peer-reviewed articles that were published after 2000 using our specific search terms and inclusion/exclusion criteria. Results The majority of psychocutaneous disorders seem to be clustered among three DSM-5 disorders: depressive disorders, anxiety disorders, and obsessive-compulsive related disorders. Conclusions Better recognition of the underlying psychiatric comorbidities may lead to improved patient outcomes.
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Affiliation(s)
- Mary Zagami
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Edward Klepper
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Eric Wienecke
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | | | - Ahmed Sikder
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Ali Ahmed
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Howard Robinson
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
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Krišto M, Lugović-Mihić L, Muñoz M, Rupnik M, Mahnic A, Ozretić P, Jaganjac M, Ćesić D, Kuna M. Gut Microbiome Composition in Patients with Chronic Urticaria: A Review of Current Evidence and Data. Life (Basel) 2023; 13:life13010152. [PMID: 36676101 PMCID: PMC9860868 DOI: 10.3390/life13010152] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 01/06/2023] Open
Abstract
Recent studies have linked gut microorganism composition and chronic urticaria (CU); however, the underlying mechanisms responsible for this connection are unknown. Since the human immune system is in homeostasis with microbiota, and the composition of the microbiome regulates the development and function of the immune system, it is likely that an alteration of microbiota components (a dysbiosis) could influence the course of chronic spontaneous urticaria (CSU), including disease severity, patient quality of life and treatment outcome. To date, several studies have identified changes in the gut microbiota composition of patients with CSU, though only a few have exhibited metabolic abnormalities associated with gut dysbiosis. The studies on CSU patients predominantly showed that the relative abundance of beneficial bacteria was decreased (Firmicutes and Bacteroides), while that of opportunistic bacteria was increased (Enterobacteria and Proteobacteria). In addition, serum metabolome analysis revealed that gut microbiota-associated alterations in unsaturated fatty acids and the butanoate metabolism pathway may play a role in CSU. These findings are potentially associated with inflammation mediated by the imbalance of Th1/Th2/Th17 cytokines, which might contribute to CSU pathogenesis. Further research in this field could improve clinical, diagnostic, and therapeutic approaches to patients with CSU. By applying new knowledge on gut microbial communities and metabolomics, future CSU therapies could modify the microbiota composition using agents such as probiotics or other similar agents, which, in combination with current standard therapies, could hopefully lead to a reduction in symptoms and an improved quality of life for CSU patients.
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Affiliation(s)
- Mirela Krišto
- Department of Dermatovenereology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Liborija Lugović-Mihić
- Department of Dermatovenereology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
- School of Dental Medicine, 10000 Zagreb, Croatia
- Correspondence: ; Tel.: +385-1-3787-480
| | - Melba Muñoz
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, and Humboldt-Universität zu Berlin, 13125 Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, 13125 Berlin, Germany
| | - Maja Rupnik
- Department for Microbiological Research, National Laboratory for Health, Environment and Food, SI-2000 Maribor, Slovenia
- Department of Microbiology, Faculty of Medicine, University of Maribor, SI-2000 Maribor, Slovenia
| | - Aleksander Mahnic
- Department for Microbiological Research, National Laboratory for Health, Environment and Food, SI-2000 Maribor, Slovenia
| | - Petar Ozretić
- Laboratory for Hereditary Cancer, Division of Molecular Medicine, Ruđer Bošković Institute,10000 Zagreb, Croatia
| | - Morana Jaganjac
- Laboratory for Oxidative Stress, Ruđer Bošković Institute, 10000 Zagreb, Croatia
| | - Diana Ćesić
- Department of Dermatovenereology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Matea Kuna
- Department of Dermatovenereology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
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Liu W, Xu R, Wang F. Recent Advances of Basophils in Pruritic Skin Diseases. J Invest Dermatol 2023; 143:691-698. [PMID: 36608999 DOI: 10.1016/j.jid.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023]
Abstract
Basophils are a rare type of granulocyte in peripheral blood. Owing to their accessibility in circulation and similarities to mast cells, basophils were considered a tool to gain insight into the function of mast cells. However, recent studies have uncovered that basophils have unique biology, specifically in activation, recruitment, and potential biomarkers. Accordingly, some previously unrecognized functions, particularly in neuroimmunology, have been found, suggesting a role of basophils in inflammatory and pruritic disorders. In this review, we aim to present an overview of basophil biology to show how basophils contribute to certain pruritic skin diseases.
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Affiliation(s)
- Wenhui Liu
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Xu
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fang Wang
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Zhang L, Qiu L, Wu J, Qi Y, Gao X, He C, Qi R, Wang H, Yao X, Zhu H, Li Y, Hao S, Lu Q, Long H, Lian S, Zhu W, Zhang H, Lai W, Su X, Lu R, Guo Z, Li J, Li M, Liu Q, Wang H, He L, Nong X, Li F, Li Y, Yao C, Xu J, Tang H, Wang D, Li Z, Yu H, Xiao S, An J, Pu X, Yu S, Zhang J, Chen X, Wang H, Huang W, Chen H, Xiao T. GWAS of Chronic Spontaneous Urticaria Reveals Genetic Overlap with Autoimmune Diseases, Not Atopic Diseases. J Invest Dermatol 2023; 143:67-77.e15. [PMID: 35933036 DOI: 10.1016/j.jid.2022.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/03/2022] [Accepted: 07/09/2022] [Indexed: 02/08/2023]
Abstract
Although chronic spontaneous urticaria (CSU) is a common disease, GWASs of CSU are lacking. We aimed to identify susceptibility SNPs by performing a GWAS in Chinese Han adults with CSU. The discovery cohort included 430 CSU cases and 482 healthy controls. The GWAS findings were validated in 800 CSU cases and 900 healthy controls. Genetic, functional enrichment, and bioinformatic analyses of genome-wide significant SNPs were performed to assess the association between CSU and autoimmunity or atopy. Five genome-wide significant SNPs were identified: rs434124/LILRA3, rs61986182/IGHG1/2, rs73075571/TDGF1, rs9378141/HLA-G, and rs3789612/PTPN22. The first four SNPs were in linkage disequilibrium with autoimmune-related diseases‒associated SNPs and were cis-expression quantitative trait loci in immune cells. The five SNPs-annotated genes were significantly enriched in immune processes. Higher polygenic risk scores and allele frequencies of rs3789612∗T, rs9378141∗C, and rs73075571∗G were significantly associated with autoimmune-related CSU phenotypes, including positive antithyroglobulin IgG, positive anti-FcεRIα IgG, total IgE <40 IU/ml, and positive antithyroid peroxidase IgG but not with atopic or allergic sensitized CSU phenotypes. This GWAS of CSU identifies five risk loci and reveals that CSU shares genetic overlap with autoimmune diseases and that genetic factors predisposing to CSU mainly manifest through associations with autoimmune traits.
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Affiliation(s)
- Liming Zhang
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Li Qiu
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Jian Wu
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Yumeng Qi
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Xinghua Gao
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Chundi He
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Ruiqun Qi
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Hexiao Wang
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Xu Yao
- Department of Allergy and Rheumatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Hong Zhu
- Department of Allergy and Rheumatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yuzhen Li
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Siyu Hao
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qianjin Lu
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hai Long
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Lian
- Department of Dermatology, Xuan Wu Hospital Capital Medical Univerisity, Beijing, China
| | - Wei Zhu
- Department of Dermatology, Xuan Wu Hospital Capital Medical Univerisity, Beijing, China
| | - Haiping Zhang
- Department of Dermatology, Xuan Wu Hospital Capital Medical Univerisity, Beijing, China
| | - Wei Lai
- Department of Dermatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiangyang Su
- Department of Dermatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongbiao Lu
- Department of Dermatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zaipei Guo
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Jingyi Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Mengmeng Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Quanzhong Liu
- Department of Dermatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huiping Wang
- Department of Dermatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Li He
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiang Nong
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fuqiu Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, China
| | - Yang Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, China
| | - Chunli Yao
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, China
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital, Fudan Univeristy, Shanghai, China
| | - Hui Tang
- Department of Dermatology, Huashan Hospital, Fudan Univeristy, Shanghai, China
| | - Duoqin Wang
- Department of Dermatology, Huashan Hospital, Fudan Univeristy, Shanghai, China
| | - Zhenlu Li
- Department of Dermatology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Huiqian Yu
- Department of Dermatology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shengxiang Xiao
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Jingang An
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Xiongming Pu
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Key Laboratory of Dermatology Research (XJYS1707), Xinjiang, China
| | - Shirong Yu
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Key Laboratory of Dermatology Research (XJYS1707), Xinjiang, China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Xue Chen
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Haifeng Wang
- Department of Genetics, Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai (CHGC), Shanghai Institute for Biomedical and Pharmaceutical Technologies (SIBPT), Shanghai, China
| | - Wei Huang
- Department of Genetics, Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai (CHGC), Shanghai Institute for Biomedical and Pharmaceutical Technologies (SIBPT), Shanghai, China
| | - Hongduo Chen
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Ting Xiao
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China.
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Shi Y, Guo H, Du Y, Wang J, Shang Y, Wang Y. Acupuncture combined with pricking and cupping therapy is effective in patients with chronic spontaneous urticaria. Am J Transl Res 2023; 15:1195-1203. [PMID: 36915747 PMCID: PMC10006817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/08/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To determine the effects of acupuncture combined with pricking and cupping therapy on the balance of Th1/Th2 cytokines in patients with chronic spontaneous urticaria (CSU). METHODS The medical records of 75 patients with CSU treated in The First Affiliated Hospital of Hebei College of Traditional Chinese Medicine from January 10, 2021 to January 10, 2022 were collected and analyzed retrospectively. Among them, 35 patients treated with traditional therapy were assigned to a control group, and 40 patients treated with acupuncture combined with pricking and cupping therapy to an observation group. The clinical efficacy and adverse reactions in the two groups were compared after therapy. The two groups were also compared in terms of the levels of immunoglobulin (Ig)-E, interleukin (IL)-4 and interferon-γ (INF-γ) before and after therapy. In addition, the visual analogue scale (VAS) for pruritus was adopted for recording the pruritus degree of patients before and after therapy. The Dermatology Quality of Life Index (DLQI) was adopted to compare the quality of life between the two groups before and after therapy. The Hamilton anxiety scale (HAMA) and Hamilton depression rating scale (HAMD) were adopted for comparison of the anxiety and depression between the two groups before and after therapy. Moreover, the Pittsburgh sleep quality index (PSQI) was used to compare sleep quality between the two groups before and after therapy. RESULTS The control group showed a significantly lower total response rate than the observation group (P<0.05). Compared with the control group, the observation group showed significantly lower levels of IgE and IL-4, and a higher IFN-γ level and had significantly lower pruritus-VAS, DLQI, HAMA, HAMD and PSQI scores (P<0.05). Additionally, the two groups were not greatly different in adverse reactions (nausea, sleepiness, ecchymosis and dizziness) (P>0.05). CONCLUSION Acupuncture combined with pricking and cupping therapy is highly effective in CSU, because it can significantly alleviate the symptoms as well as negative emotions, and improve the quality of life, sleep quality and the balance of Th1/Th2 cytokine in patients.
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Affiliation(s)
- Yu Shi
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Hebei College of Traditional Chinese Medicine Shijiazhuang 050011, Hebei, China
| | - Haichao Guo
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Hebei College of Traditional Chinese Medicine Shijiazhuang 050011, Hebei, China
| | - Yuzhu Du
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Hebei College of Traditional Chinese Medicine Shijiazhuang 050011, Hebei, China
| | - Jin Wang
- Department of Oncology, Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine Beijing 100000, China
| | - Yan Shang
- Department of Neurology, Dingzhou Hospital of Traditional Chinese Medicine Dingzhou 073000, Hebei, China
| | - Yanjun Wang
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Hebei College of Traditional Chinese Medicine Shijiazhuang 050011, Hebei, China
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Segú-Vergés C, Gómez J, Terradas-Montana P, Artigas L, Smeets S, Ferrer M, Savic S. Unveiling chronic spontaneous urticaria pathophysiology through systems biology. J Allergy Clin Immunol 2022; 151:1005-1014. [PMID: 36587849 DOI: 10.1016/j.jaci.2022.12.809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a rare, heterogeneous, severely debilitating, and often poorly controlled skin disease resulting in an itchy eruption that can be persistent. Antihistamines and omalizumab, an anti-IgE mAb, are the only licensed therapies. Although CSU pathogenesis is not yet fully understood, mast cell activation through the IgE:high-affinity IgE receptor (FcεRI) axis appears central to the disease process. OBJECTIVE We sought to model CSU pathophysiology and identify in silico the mechanism of action of different CSU therapeutic strategies currently in use or under development. METHODS Therapeutic performance mapping system technology, based on systems biology and machine learning, was used to create a CSU interactome validated with gene expression data from patients with CSU and a CSU model that was used to evaluate CSU pathophysiology and the mechanism of action of different therapeutic strategies. RESULTS Our models reflect the known role of mast cell activation as a central process of CSU pathophysiology, as well as recognized roles for different therapeutic strategies in this and other innate and adaptive immune processes. They also allow determining similarities and differences between them; anti-IgE and Bruton tyrosine kinase inhibitors play a more direct role in mast cell biology through abrogation of FcεRI signaling activity, whereas anti-interleukins and anti-Siglec-8 have a role in adaptive immunity modulation. CONCLUSION In silico CSU models reproduced known CSU and therapeutic strategies features. Our results could help advance understanding of therapeutic mechanisms of action and further advance treatment research by patient profile.
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Affiliation(s)
- Cristina Segú-Vergés
- Anaxomics Biotech, Barcelona, Spain; Research Programme on Biomedical Informatics, Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | | | | | - Marta Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra, 3Cooperative Research Network Health Oriented, Pamplona, Spain
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom.
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Efficacy of Different Dosing Regimens of IgE Targeted Biologic Omalizumab for Chronic Spontaneous Urticaria in Adult and Pediatric Populations: A Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10122579. [PMID: 36554102 PMCID: PMC9778713 DOI: 10.3390/healthcare10122579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Chronic urticaria is a debilitating skin condition that is defined as itchy hives at least twice a week and lasting for six or more weeks, with or without angioedema. Chronic spontaneous urticaria (CSU) is a form of disease that is witnessed in two-thirds of those with chronic urticaria. This meta-analysis explores the efficacy of differential dosages of omalizumab for outcomes of weekly itching scores, weekly wheal scores, urticarial assessment score 7 (UAS7), and responder rates. Adhering to PRISMA Statement 2020 guidelines, a systematic search of PubMed/MEDLINE, Scopus, Embase, and Web of Science was conducted until 15 September 2022. A combination of the following keywords was used: omalizumab and chronic urticaria. Data comprising clinical trial ID, name, author/year, country, dosage and time of intervention, inclusion criteria, mean age, female gender, and racial grouping information were obtained. The meta-analytical outcomes were analyzed in RevMan 5.4. The risk-of-bias assessment was conducted using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). A total of 10 trials comprising 1705 patients with CSU were included. Notably, 1162 belonged to the intervention group, while 543 were controls. A total of 70.4% of the participants were female in the intervention group, while 65.6% of them were female in the control group. The overall mean age was 38.64 ± 10.66 years. Weekly itch score outcomes were most notable with 150 mg dosage (Cohen’s d = −2.6, 95% CI = −4.75, −0.46, p = 0.02). The weekly wheal score outcomes had the largest effect size with 300 mg dosage (Cohen’s d = −1.45, 95% CI = −2.2, −0.69, p = 0.0002). For UAS7 outcomes, the largest effect size was yielded with 150 mg dosage (Cohen’s d = −6.92, 95% CI: −10.38, −3.47, p < 0.0001). The response rate to omalizumab had a likelihood of being higher with 300 mg of intervention compared to placebo (OR = 8.65, 95% CI = 4.42, 16.93, p < 0.0001). Well-rounded urticarial symptom resolution was observed with 150 mg and 300 mg dosages of omalizumab. Improvement of UAS7 was more comparable with 150 mg dosage, whereas the chance of response to treatment was higher with 300 mg dosage. Our findings support omalizumab as an effective intervention for adult and pediatric populations that are resistant to many therapies, including high-dose H1-antihistamines.
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46
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Rolla G. Chronic Urticaria. N Engl J Med 2022; 387:2102-2103. [PMID: 36449441 DOI: 10.1056/nejmc2212742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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47
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Ben-Fredj N, Chahed F, Ben-Fadhel N, Mansour K, Ben-Romdhane H, Mabrouk RSE, Chadli Z, Ghedira D, Belhadjali H, Chaabane A, Aouam K. Case series of chronic spontaneous urticaria following COVID-19 vaccines: an unusual skin manifestation. Eur J Clin Pharmacol 2022; 78:1959-1964. [PMID: 36255482 PMCID: PMC9579615 DOI: 10.1007/s00228-022-03399-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Urticaria following the COVID-19 vaccine was rarely reported and had a short self-limited resolution. However, there has been relatively little literature published on CSU induced by COVID-19 vaccines. PURPOSE We describe a case series of patients who experienced CSU after SARS-CoV-2 vaccination. METHODS A retrospective case series of 10 patients referred to the Department of Clinical Pharmacology of the University of Monastir (January 2021-January 2022) and included for evaluation of urticaria after COVID-19 vaccination. RESULTS The median age was 31 years and patients were mostly female. Atopy was presented in 3 patients and urticaria was accompanied by angioedema in 6 patients. The median time interval between vaccination and the onset of urticaria was 28.5 h. The offended dose was the first one in 8 patients. The resolution of the eruption was observed at least 2 months later, despite the regular use of a full dose of antihistamine in nine patients. Polynuclear leucocytosis was identified in 5 patients. Anti-TPOAb was positive in one patient after receiving the BNT162b2 vaccine. Total serum IgE was elevated in 4 patients. Skin tests for the suspected vaccine as well as the vaccine excipient were negative. CONCLUSION We add to the medical literature ten new cases of chronic spontaneous urticarial reactions following COVID-19 vaccines uncontrolled with high-dose first-generation H1 antihistamines.
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Affiliation(s)
- Nadia Ben-Fredj
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| | - Ferdaous Chahed
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia.
| | - Najah Ben-Fadhel
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| | - Khadija Mansour
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| | - Haifa Ben-Romdhane
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| | - Randa Said El Mabrouk
- Department of Dermatology, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Zohra Chadli
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| | - Donia Ghedira
- Department of Chemistry, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Hichem Belhadjali
- Department of Dermatology, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Amel Chaabane
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| | - Karim Aouam
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
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Hu Y, Geere M, Awan M, Leavitt AD, Brown LE, Pearson HJ, Gandelman JS, Kogan SC. Dapsone-induced methemoglobinemia and hemolysis in a woman without G6PD deficiency presenting with idiopathic urticaria. Hematology 2022; 27:1253-1258. [PMID: 36444994 PMCID: PMC9788447 DOI: 10.1080/16078454.2022.2149943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The appearance of bite cells associated with methemoglobinemia can be caused by oxidizing drugs such as dapsone in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency or high drug serum levels. Bite cells are often pathognomonic for oxidant injury in patients with G6PD deficiency and suggest active hemolysis. CASE PRESENTATION We report a case of a woman with no prior history of G6PD deficiency who presented with anemia, methemoglobinemia and bite cells on peripheral blood smear after dapsone therapy for new onset idiopathic urticaria. Laboratory tests for G6PD, blood count and liver function were within normal limits prior to initiation of therapy. During the patient's hospital course, moderate methemoglobinemia and anemia were identified despite mildly increased serum G6PD level. These pathologies were reversed upon stopping dapsone therapy. CONCLUSION This case highlights the potential for therapeutic levels of dapsone to induce side effects in patients without G6PD deficiency and highlights the importance of routine blood monitoring for anemia and hemolysis during the course of drug therapy.
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Affiliation(s)
- Yang Hu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
- Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI. USA
| | - Mimansa Geere
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Maham Awan
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Andrew D. Leavitt
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laura E. Brown
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Hadley J. Pearson
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Jocelyn S. Gandelman
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Scott C. Kogan
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
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Jia F, Zhao Q, Shi P, Liu H, Zhang F. Dupilumab: Advances in the off-label usage of IL4/IL13 antagonist in dermatoses. Dermatol Ther 2022; 35:e15924. [PMID: 36219538 DOI: 10.1111/dth.15924] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/04/2022] [Indexed: 12/29/2022]
Abstract
Type 2 immune response refers to a complicated series of immune responses characterized by Th2 polarization and Th2 cytokines secretion. The IgE secretion, airway hypersensitivity, and effector cell recruitment (eosinophils, mast cells, basophils) in skin lesion and peripheral blood stream could be upregulated during the activation of type 2 immune response. Th1/Th2 ratio, also referred as Th1/Th2 balance, represent the T lymphocytes immune pattern to a certain degree: Th1-dominated responses are often involved in intracellular infections (e.g., mycobacterium tuberculosis) and autoimmune diseases (e.g., Graves' disease) while Th2-dominated responses are involved in allergic conditions (e.g., atopic dermatitis, eczema), IgE mediated diseases (e.g., urticaria), and fibrotic dermatoses (e.g., keloids). Dupilumab, as one of the most widely applied Th2 cytokine inhibitors, could block the bioactivity of IL-14/IL-13 via competitively binding to the common IL-4Rα subunit shared by IL-4 and IL-13 receptors. In addition to the direct inhibition of type 2 response, dupilumab is also effective in autoimmune and some infectious skin diseases through indirect regulation of type 1 immune response. The pathological mechanism of Th2 responses and advanced clinical application of dupilumab in skin diseases will be summarized and discussed in the review.
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Affiliation(s)
- Fengming Jia
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Qing Zhao
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Peidian Shi
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Hong Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Furen Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
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50
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Do Antinuclear Antibodies Influence the Clinical Features of Chronic Spontaneous Urticaria?: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7468453. [PMID: 36483629 PMCID: PMC9726248 DOI: 10.1155/2022/7468453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/05/2022]
Abstract
Background Antinuclear antibody (ANA) is often used as a screening test for autoimmune comorbidities in patients with chronic spontaneous urticaria (CSU). However, the relationship of ANA status and the clinical course of the disease have not been fully described. Objectives To compare clinical features of CSU patients who are positive and negative for ANA. Methods This was a retrospective cohort study that enrolled CSU patients attending the Urticaria Clinic at Siriraj Hospital from 2013 to 2019. Demographics, clinical characteristics, laboratory investigations, and treatments were collected until July 2021. All patients were investigated for ANA. Clinical feature data was compared between CSU patients with positive ANA and negative ANA groups using the 2-sample t-test and the Mann-Whitney U test for quantitative variables. The chi-squared test or Fisher's exact test was conducted to explore the association of qualitative variables. Disease relapse and remission were analysed via Kaplan-Meier survival analysis. Results Of 323 CSU patients, 31% had positive ANA. There were no significant differences in disease severity or impairment in quality of life. Patients with a positive ANA test had significantly lower prevalence of allergic rhinitis (p = .048) and significantly higher level of erythrocyte sedimentation rate (p = 0.007). Kaplan-Meier survival analysis showed that 2% of ANA positive CSU patients achieved remission status after one year and 28% did so after five years. There was no statistically significant difference in time to remission and time to relapse between ANA-positive and negative groups. Conclusion Positive ANA in CSU patients could not indicate the differences in main disease characteristics from the ANA-negative CSU patients. Investigation for ANA may be useful in CSU patients who are suspected of having autoimmune diseases.
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