Clinical Characterization of Patients with Chronic Spontaneous Urticaria according to Anti-TPO IgE Levels

الملخص EN

Background.

Chronic spontaneous urticaria (CSU) is a heterogeneous disease with some frequent comorbidities like autoimmune diseases, drug reactions, and inducible urticaria.

IgE antibodies against thyroid peroxidase (anti-TPO IgE) could be associated with some of these clinical characteristics.

Objective.

To explore the clinical characteristics of CSU patients, according to the presence of anti-TPO IgE in serum.

Methods.

Anti-TPO IgE levels were measured during the clinical control period (Urticaria Activity Score, 0 point) and exacerbation period (≥3 points) in 100 CSU patients.

Patients with self-reported exacerbation of skin involvement by foods, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical triggers underwent controlled challenge tests.

Results.

We identified 2 groups of patients: (1) patients with anti-TPO IgE during the clinical control period or during an exacerbation, who had a higher frequency of atopy, asthma, and positive challenge test results with NSAIDs and (2) patients without anti-TPO IgE during any period, who had a higher frequency of positive challenge test results for inducible urticaria.

Among the first group (anti-TPO IgE at any point), we identified 3 subgroups: patients with anti-TPO IgE during the clinical control period (n=12); patients with anti-TPO IgE during the clinical control period and significantly increased levels during an urticaria exacerbation (n=18); and patients with anti-TPO IgE only during an exacerbation (n=13).

None of the patients with self-reported food reactions had a positive challenge test result.

Conclusion.

Anti-TPO IgE is a useful biomarker for differentiating between clinical phenotypes of patients with CSU.

Elevation of anti-TPO IgE during exacerbation periods supports an association between this autoantibody and the pathogenesis of urticaria.