Autoimmune urticaria

Autoimmune urticaria. This seems to be an underlying basis of many cases of chronic idiopathic urticaria. About one third of patients with chronic urticaria spontaneously develop auto-antibodies directed at the receptor FceRI, located on skin mast cells. Chronic stimulation of this receptor leads to chronic hives. Patients often have other autoimmune conditions, such as autoimmune thyroiditis. 

Omalizumab, a recombinant humanized monoclonal antibody that inhibits the binding of human IgE to its high-affinity receptor FceRI by selectively binding the immunoglobulin in solution, has been used as a successful treatment of intractable allergic asthma. The efficacy of the monoclonal antibody treatment was therefore investigated in patients with chronic autoimmune urticaria who remained symptomatic on antihistamine therapy. Of the 12 patients treated, seven showed complete resolution of the urticaria, four responded with a decrease in the urticaria activity score but the urticaria persisted, and one patient showed no improvement. 

Echinacea (Echinacea purpurea) Uses immune system stimulant prevention/Rx of colds, flu as supportive th apy for colds chronic infxns of the resp tract lower urinary tract Action Stimulates phagocytosis cytokine production T resp cellular activity topically exerts anesthetic, antimicrobial, anti-inflammatory effects Efficacy Not established may X severity duration of URI Available forms Caps w/ powdered herb equivalent to 300-500 mg, PO, tid pressed juice 6-9 mL, PO, once/d tine 2-4 mL, PO, tid (1 5 dilution) tea 2 tsp (4 g) of powdered herb in 1 cup of boiling water Noles/SE Fever, taste p -version, urticaria, angioedema Contra w/ autoimmune Dz, collagen Dz, progressive systemic Dz (TB, MS, collagen-vascular disorders), HIV, leukemia, may interfere w/ immunosuppressive therapy Interactions t Risk of disulfiram-like reaction W/ disulfiram, metronidazole T risk of exacerbation of HIV or AIDS W/ chinacea amprenavir, other protease inhibitors X effects OF azathioprine, basiliximab, corticosteroids, cyclosporine, daclizumab, econazole vag cream, muromonab-CD3, mycophenolate, prednisone, tacrolimus EMS Possible immunosuppression... 

Serious, acute hypersensitivity reactions, such as urticaria, angioedema, broncho-constriction, and anaphylaxis, may occur. Other rare reactions include pancreatitis, colitis, endocrine disorders (e.g., diabetes mellitus), hyperthyroidism or hypothyroidism, ophthalmologic, neuropsychiatric, autoimmune, ischemic, infectious, and pulmonary disorders. 

The risk of reactions to antilymphocyte globulin is increased in patients with autoimmune disease (126). Fever and chills, sometimes with extreme hyperpyrexia, nausea and vomiting, urticaria, and reduced platelet and granulocyte counts were reported after the administration of horse antithymocyte globulin. 

Infusion of intravenous immunoglobulin 0.14 g/kg in 17 patients with autoimmune diseases, in whom circulating immunoglobulins had been depleted, was associated with a high incidence of serious adverse effects (94). Treatment was terminated in four patients because of adverse effects, including urticaria, severe hypotension, arthralgia, and chest discomfort. 

Infusion reactions (fever, rigors, fatigue, musculoskeletal pain, dyspnea, hypotension, urticaria) autoimmune hemolytic anemia Erythema rash pruritus... 

Abramson and Schulz (1971) found precipitating antibodies to OCDs in sera from women with the most severe side effects due to these drugs. These sera were negative when tested in immunodiffusion using nonrelevant steroids. Farah and Shbaklu (1971) detected antibodies to progesterone in serum from two patients with autoimmune progesterone urticaria. 

Farah FS, Shbaklu Z (1971) Autoimmune progesterone urticaria. J Allergy Clin Immunol 48 257-261... 

Strewler GJ, Orloff J (1977) Role of cyclic nucleotides in the transport of water and electrolytes. Adv Cyclic Nucleotide Res 8 311-361 Sturtridge WC, Harrison JE, Wilson DR (1977) Long-term treatment of Paget s disease of bone with salmon calcitonin. Can Med Assoc J 117 1031-1034 Tromovitch TA, Heggli WF (1967) Autoimmune progesterone urticaria. Calif Med 106 211-212... 

Cold urticaria can be idiopathic or the primary manifestation of numerous associated diseases, including allergic, infectious, autoimmune and malignant diseases, as well as complement defects and primary cryoglobulinemia (Henz et al. 1997). Abnormal serum proteins probably play a pathogenetic role in all cases. 

Urticaria is a heterogeneous disease with many subtypes caused by a range of agents and stimuli. Subtypes include urticaria due to genetic or immune mechanisms, urticaria with an autoimmune basis and nonimmune-mediated urticaria, and angioedema. 

Leznoff A, Josse RG, Denburg 1, Dolovich 1. Association of chronic urticaria and angioedema with thyroid autoimmunity. Arch Dermatol 1983 119(8) 636-640. 

Heymann WR. Chronic urticaria and angioedema associated with thyroid autoimmunity review and therapeutic impUcations. 1 Am Acad Dermatol 1999 40(2 Pt l) 229-232. 

Tong LJ, Balakrishnan G, Kochan JP, Kinet JP, Kaplan AP. Assessment of autoimmunity in patients with chronic urticaria. J Allergy CUn Immunol 1997 99(4) 461-465. 

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