Current features of diagnosing the autoimmune type of chronic spontaneous urticaria in clinical practice

Burygina EV, Kozlova YI, Frolova EV, et al. . Current features of diagnosing the autoimmune type of chronic spontaneous urticaria in clinical practice. Russian Journal of Clinical Dermatology and Venereology. 2023;22(2):186‑191. (In Russ.)
https://doi.org/10.17116/klinderma202322021186

Подписка 2026 Клиническая дерматология и венерология (Russian Journal of Clinical Dermatology and Venereology)

Использование инфографики авторами научных работ

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BACKGROUND

Chronic spontaneous urticaria (CSU) is a condition with heterogeneous immunopathogenic mechanisms. Identifying the autoimmune type of CSU is necessary for choosing proper therapeutic tactics.

OBJECTIVE

To evaluate the use of basophil activation test in clinical practice to diagnose the autoimmune type of CSU.

MATERIALS AND METHODS

The study included 125 patients with CSU aged 18 to 75 years (median 42 years); 72.8% were females. All patients were evaluated for urticaria activity using the UAS7 score and thyroid function; eosinophil and basophil counts and total IgE were determined in peripheral blood, an intradermal test with autologous serum test and an indirect basophil activation test (BAT) was performed using flow cytometry.

RESULTS

A positive BAT result was obtained in 43 (34.4%) patients with CSU. There was a higher activity of urticaria in BAT(+) patients vs. BAT(–) ones (p=0.031), angioedema (p=0.012), and hypothyroidism (p=0.002) were also more common in BAT(+) patients. There were lower eosinophil (p=0.027) and basophil (p=0.026) counts and total blood IgE (p<0.001), and a higher level of antibodies to thyroid peroxidase (p=0.004).

CONCLUSION

The inclusion of indirect BAT in the algorithm of examination of patients with CSU enables identifying cases with an autoimmune type of disease in clinical practice.

Keywords:

chronic spontaneous urticaria

autoimmune urticaria

basophil activation test

autologous serum test

flow cytometry

Authors:

Burygina E.V.

North-Western State Medical University named after I.I. Mechnikov

ORCID: 0000-0002-9307-4927

Kozlova Y.I.

North-Western State Medical University named after I.I. Mechnikov

ORCID: 0000-0002-4602-2438

Frolova E.V.

Mechnikov North-Western State Medical University

SPIN RSCI: 1212-0030
Scopus AuthorID: 37037140300
ResearcherID: O-4134-2014
ORCID: 0000-0002-5569-5175

Uchevatkina A.E.

North-Western State Medical University named after I.I. Mechnikov

ORCID: 0000-0001-6688-7781

Aak O.V.

North-Western State Medical University named after I.I. Mechnikov

ORCID: 0000-0001-8130-7503

Filippova L.V.

North-Western State Medical University named after I.I. Mechnikov

ORCID: 0000-0003-4167-7440

Melnikova A.V.

North-Western State Medical University named after I.I. Mechnikov

Raznatovsky K.I.

North-Western State Medical University named after I.I. Mechnikov

ORCID: 0000-0003-1022-7463

Vasilyeva N.V.

Mechnikov North-Western State Medical University

ORCID: 0000-0002-3700-6743

Klimko N.N.

North-Western State Medical University named after I.I. Mechnikov

ORCID: 0000-0001-6095-7531

Received:

18.06.2022

Accepted:

16.03.2023

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References:

Zuberbier T, Asero R, Grattan C, Kaplan A, Hide M, Metz M, Magerl M, Saini SS, Abdul Latiff AH, Abuzakouk M, Aquilina S, Baker D, Ballmer-Weber B, Bangert C, Bernstein JA, Ben-Shoshan M, Bindslev-Jensen C, Brockow K, Brzoza Z, Chong Neto HJ, Church MK, Criado PR, Danilycheva IV, Dressler C, Ensina LF, Fonacier L, Gaskins M, Gáspár K, Gelincik A, Giménez-Arnau A, Godse K, Gonçalo M, Grosber M, Hamelmann E, Hébert J, Kapp A, Kessel A, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Lauerma A, Leslie TA, Makris M, Meshkova RY, Micallef D, Mortz CG, Nast A, Oude-Elberink H, Pawankar R, Pigatto PD, Ratti Sisa H, Rojo Gutiérrez MI, Schmid-Grendelmeier P, Sekerel BE, Siebenhaar F, Siiskonen H, Soria A, Staubach-Renz P, Stingeni L, Sussman G, Szegedi A, Thomsen SF, Vadasz Z, Vestergaard C, Zhao Z, Wedi B, Maurer M. The international EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy Eur J Allergy Clin Immunol. 2022;(77):734-766. https://doi.org/10.1111/all.15090
Urticaria (clinical recommendations). M. 2019. 60. Accessed Jan 24, 2022. (In Russ.). https://raaci.ru/dat/pdf/KR_urticaria_2019.pdf
Bracken SJ, MacLeod AS, Abraham S. Autoimmune theories of chronic spontaneous urticaria. Front Immunol. 2019;10:1-10. https://doi.org/10.3389/fimmu.2019.00627
Schoepke N, Asero R, Ferrer M, Ellrich A, Gimenez-Arnau A, Grattan C, Jakob T, Konstantinou GN, Raap U, Skov PS, Staubach P, Kromminga A, Knol EF, Zhang K, Bindslev-Jensen C, Daschner A, Kinaciyan T, Makris M, Marrouche N, Schmid-Grendelmeier P, Sussman G, Toubi E, Church MK, Maurer M. Biomarkers and clinical characteristics of autoimmune chronic spontaneous urticaria: Results of the PURIST Study. Allergy Eur J Allergy Clin Immunol. 2019;74(12):2427-2436. https://doi.org/10.1111/all.13949
Maurer M, Altrichter S, Schmetzer O, Scheffel J, Church M, Metz M. Immunoglobulin E-mediated autoimmunity. Front Immunol. 2018;9(689):1-17. https://doi.org/10.3389/fimmu.2018.00689
Fok JS, Kolkhir P, Church MK, Maurer M. Predictors of treatment response in chronic spontaneous urticaria. Allergy Eur J Allergy Clin Immunol. 2021; 76:2965-2981. https://doi.org/10.1111/all.14757
Ertas R, Ozyurt K, Atasoy M, Hawro T, Maurer M. The clinical response to omalizumab in chronic spontaneous urticaria patients is linked to and predicted by IgE levels and their change. Allergy Eur J Allergy Clin Immunol. 2018;73(3):705-712. https://doi.org/10.1111/all.13345
Grattan C, Church MK. Aetiopathogenesis of urticaria. In: Zuberbier T, Grattan C, Maurer M. (eds) Urticaria and Angioedema. Springer, Cham. Springer International Publishing; 2021;9-24. https://doi.org/10.1007/978-3-540-79048-8_2
Konstantinou GN, Asero R, Ferrer M, Maurer M, Knol EF, Raap U. EAACI taskforce position paper: Evidence for autoimmune urticaria and proposal for defining diagnostic criteria. Allergy Eur J Allergy Clin Immunol. 2013; 68(1):27-36. https://doi.org/10.1111/all.12056
Marcelino J, Baumann K, Skov PS, Pereira Santos MC, Wyroslak I, Scheffel J, Altrichter S, Woetmann A, Pereira-Barbosa M, Costa C, Maurer M. What Basophil Testing Tells Us About CSU Patients — Results of the CORSA Study. Front Immunol. 2021;12(742470). https://doi.org/10.3389/FIMMU.2021.742470
D’Auria E, De Amici M, Licari A, Caimmi S, Mantegazza C, Zuccotti G, Marseglia G. Basophil activation test in children with autoimmune chronic spontaneous urticaria: Is it ready for clinical practice? Immunobiology. 2019; 224(1):30-33. https://doi.org/10.1016/j.imbio.2018.11.001
Bychkova NV. Basophil activation: theoretical aspects and use in the diagnosis of allergic diseases. Medical Immunology (Russia)/Meditsinskaya Immunologiya. 2021;23(3):469-482. (In Russ.). https://doi.org/10.15789/1563-0625-BAT-2174
Kozlova YI, Frolova EV, Uchevatkina AE, Filippova LV, Mitrofanov VS, Aak OV, Solovyova GI, Kuznetsov VD, Vasilyeva NV, Klimko N.N. Diagnostic possibilities of basophil activation test in the identification of allergic bronchopulmonary asphergilosis in patients with asthma. Problemy meditsinskoi mikologii. 2018;20(4):15-19. (In Russ.).
Sinel’nikova NA, Savenkova ND, Kalinina NM. Investigation of causal factors, clinical and immunological features of spontaneous and induced chronic urticaria in children. Meditsina teoriya i praktika. 2019;4(S):511-512.(In Russ.).
Konstantinou GN, Asero R, Maurer M, Schmid-Grendelmeier P, Sabroe RA, Grattan C. EAACI/GA2LEN task force consensus report: The autologous serum skin test in urticaria. Allergy Eur J Allergy Clin Immunol. 2009; 64(9):1256-1268. https://doi.org/10.1111/j.1398-9995.2009.02132.x
Hoffmann HJ, Knol EF, Ferrer M, Eberlein B, Mayorga L, Nopp A, Sabato V, Santos AF, MacGlashan D. Pros and Cons of Clinical Basophil Testing (BAT). Curr Allergy Asthma Rep. 2016;16(8):1-12. https://doi.org/10.1007/s11882-016-0633-6
Kolkhir P, Church MK, Altrichter S, Hawro T, Skov PS, Metz M, Frischbutter S, Maurer M. Eosinopenia, in Chronic Spontaneous Urticaria, Is Associated with High Disease Activity, Autoimmunity, and Poor Response to Treatment. J Allergy Clin Immunol Pract. 2020;8(1):318-325.e5. https://doi.org/10.1016/j.jaip.2019.08.025
Puxeddu I, Petrelli F, Croia C, Angelotti F, Migliorini P. Biomarkers in chronic spontaneous urticaria: Current targets and clinical implications. J Asthma Allergy. 2019;12:285-295. https://doi.org/10.2147/JAA.S184986
Kolkhir P, Kovalkova E, Chernov A, Danilycheva I, Krause K, Sauer M, Fomina D, Shulzhenko A, Maurer M. Autoimmune Chronic Spontaneous Urticaria Detection with IgG Anti-TPO and Total IgE. J Allergy Clin Immunol Pract. 2021;9(11):4138-4146.e8. https://doi.org/10.1016/j.jaip.2021.07.043