( Chronic idiopathic urticaria ) ( Autoimmune urticaria ) Anti-Fc RI ( E ) ( Thyroid autoimmunity ) ( ) ( wh eal ) ( family Urticaceae/nettle family )

Transcription

1 E E E ( hronic idiopathic urticaria ) ( Autoimmune urticaria ) Anti-Fc RI ( E ) ( Thyroid autoimmunity ) r a s h ( urticaria ) h i v e s n e t t l e ( wh eal ) ( family Urticaceae/nettle family ) ( Urtica thunbergiana )

2 28 ( Laportea pterostigma ) ( urticarial vasculitis ) ( idiopathic ) ( physical urticaria ).. ( SLE ) ( Sjogren's syndrome ) ( cryoglobulinemia ) 1 0 ( chronic idiopathic urticaria, IU ) ( basophil ) ( dermal mast cell ) E ( high affinity IgE receptor Fc RI ) - a n t i - Fc RI antibodies 2 ( ) E ( IgE ) -anti-ige antibodies 3, 4 ( cross- ( type I/immediate-type hypersensitivity ) I g E link ) I g E - Fc R I ( mediator ) (autoimmune urticaria ) 5, 6 7, 8 F c R I w h e a l - a n d - f l a r e 1986 G r a t t a n ( autologous serum ) ( intradermal injection ) w h e a l - a n d - f l a r e bacter pylori ) 9 ( H e l i c o ( autologous serum skin test, ASST ) 1 2 w h e a l - a n d - f l a r e ( histamine releasing factors ) wheal flare ( axon reflex ) ( angioedema ) 1 3 G ( IgG ) H i d e 1993 Fc R I ( recombinant soluble alpha chain of the Fc RI, sfc R I ) I g G

3 29 I g E ( Fc RI ) - a n t i - Fc R I - I g E 1 4 I g E - a n t i - I g E I g E I g E ( IgE sensitized ) I g E histamine release assay ) 1 5 ( basophil m l ( 10 g / m l ) 0.05 ml mm 80 % 50 % 50 % ( ) factor ) ( mast cell-specific histamine releasing 2 1 a n t i - Fc R I ( Western blot ) ( enzyme-linked immunosorbent assay, 2 2 2, 2 3 ELISA ) 16, 17 ( SLE ) ( dermatomyositis ) ( pemphigus vulgaris ) ( bullous pemphigoid ) 1 7 a n t i - I g E - - a n t i - Fc R I R o s e ( intravenous immunoglobulin, IVIG ) I g G ( non-functional ) I g G 2 I g G 4 I g G 1 1 7, % 6 0 % ( 25% 40% ) % 4 0 % a n t i - F c R I 3 5 % 1 0 % a n t i - I g E 1 2 3, 1 5, 2 0 ( gold standard ) ml B o n a 24 ( 1 ) T ( 2 ) ( 3 ) ( 1 ) w h e a l - a n d - f l a r e ( 3 ) , 2 7 ( 2 ) ( HLA ) H L A D R B 1 * 04 ( DR4 ) DQB1*0302 ( DQ8 ) 2 8

4 30 ( antithyroid antibodies, ATAs ) 7, 8 a n t i - thyroglobulin ( anti-tg ) a n t i - t h y r o p e r o x i d a s e / microsomal ( anti-tpo ) L e z n o ff 1983 m i c r o s o m a l 1 2 % 5. 6 % 2 9 Tu r k t a s % a n t i - T G % m i c r o s o- m a l 3. 7 % G a i g % Z a u l i ( 29% ) a n t i - T G a n t i - T P O anti-tsh rec e p t o r 14 ( T SH ) A s e r o ( 26% ) Ve r n e u i l % 3. 3 % To u b i ( 12% ) ( p=0.004 ) % 29 % ( 1% 10% ) 8 Ve r n e u i l To u b i % 50 % 52 % 16 % L a n i g a n A 50 B A 28 % B 4 % 6 % A B ( thyroid autoimmunity ) a n t i - Fc R I ( ) K i k u c h i % 10.9% ( p<0.001 ) a n t i - Fc R I F u s a r i 62 % 39 % ( p>0.05 ns ) 28 ( 14 ) ASST ( 86.7% ) ( 8 % ) ASS T ( p<0.001 ) 39 ( ) 3 4 K a n d e e l I g E ( Hashimoto thyroiditis ) 7, 8

5 31 4 0, 4 1 ( thyroxine ) ( euthyroid ) 47 % 42 8 We d i 9 1 % 50 % 5 5 Di ampli a m o x i c i l l i n c l a r i t h r o m y c i n l a n s o- p r a z o l e 88 % 5 6 A B ( pre-icteric phase ) B % B 5 % phase ) , 4 4 A 9 % B ( pre-icteric S c h n y d e r ( double-blind placebo-controlled crossover study ) a m o x i- c i l l i n l a n s o p r a z o l e F e d e r m a n % % E r e l % ( odds ratio ) 2.9 ( 95% P =.005 ) ( anti-hv ) 22% R N A % 0 2 % % ( Helicobacter pylori ) / H 1 / H 1 ( H1 antihistamine/histamine H1 receptor antagonist ) 6 0 acrivastine ( Semprex ) cetirizine ( Zyrtec ) desloratidine ( larinex ) fexodenadine ( Allegra ) levocetirizine ( Xyzal ) loratadine ( larityne ) m i z o l a s t i n e 5 9 mimicry ) 9 ( m ol ec u lar c h l o r p h e n i- r a m i n e diphenhydramine ( Benadryl) h y d r o x- yzine ( Vistaril )

6 32 ( A l l e g r a 240 mg ) 6, 6 0 H 2 H 2 ( flare ) H 1 H 2 ( leukotriene receptor an- m o n- H 2 tagonist ) 6 1 H 1 H 2 H 2 H 1 H 1 H , 60 Doxepin ( Sinequan ) H 1 H 2 t e l u k a s t z a f i r l u k a s t 30 ( single blind placebo-controlled crossover study ) m o n t e l u k a s t c e t i r i z i n e c e t i r i z i n e c e t i r i z i n e d e s l o r a t a d i n e m o n t e l u k a s t d e s l o r a t a d i n e m o n- t e l u k a s t d e s l o- r a t a d i n e m o n t e l u k a s t l u k a s t l u k a s t 6 3 z a f i r l u k a s t c e t i r i z i n e z a f i r l u k a s t z a f i r l u k a s t z a f i r- 6 4 z a f i r l u k a s t z a f i r- 6 5 H 2 H p r e d n i s o l o n e c y - closporin c y c l o s p o r i n c l o s p o r i n 2.5~5 mg/kg/day c y c l o s p o r i n c y - y c l o s p o r i n G r e a v e s c y c l o s p o r i n m e t h o t r e x a t e h y d r o x y c h l o r o q u i n e venous immunoglobulin, IVIG ) ( plasmapheresis ) 26, 27 A n t i - Fc R I a n t i - I g E t a c r o l i m u s 6 ( in tr a- 7 2

7 33 1.Zuberbier T, Greaves MW, Juhlin L, et al. Definition, classification, and routine diagnosis of urticaria: a consensus report. J Investig Dermatol Symp Proc 2001; 6: Sheikh J. Autoantibodies to the high-affinity IgE receptor in chronic urticaria: how important are they? urr Opin Allergy lin Immunol 2005; 5: Kaplan AP. hronic urticaria: pathogenesis and treatment. J Allergy lin Immunol 2004; 114: Greaves M. Autoimmune urticaria. lin Rev Allergy Immunol 2002; 23: Grattan. Autoimmune urticaria. Immunol Allergy lin North Am 2004; 24: Sabroe RA, Greaves MW. hronic idiopathic urticaria with functional autoantibodies: 12 years on. Br J Dermatol 2006; 154: Dreskin S, Andrews KY. The thyroid and urticaria. urr Opin Allergy lin Immunol 2005; 5: Doutre MS. hronic urticaria and thyroid auto-immunity. lin Rev Allergy Immunol 2006; 30: Wedi B, Raap U, Kapp A. hronic urticaria and infections. urr Opin Allergy lin Immunol 2004; 4: Grattan E, Sabroe RA, Greaves MW. hronic urticaria. J Am Acad Dermatol 2002; 46: Grattan E, Wallington TB, Warin RP, Kennedy T, Bradfield J W. A serological mediator in chronic idiopathic urticaria--a clinical, immunological and histological evaluation. Br J Dermatol 1986; 114: Sabroe RA, Grattan E, Francis DM, et al. The autologous serum skin test: a screening test for autoantibodies in chronic idiopathic urticaria. Br J Dermatol 1999; 140: Grattan E, Francis DM, Hide M, Greaves MW. Detection of circulating histamine releasing autoantibodies with functional properties of anti-ige in chronic urticaria. lin Exp Allerg y 1991; 21: Hide M, Francis DM, Grattan E, Hakimi J, Kochan JP, Greaves MW. Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 1993; 328: Niimi N, Francis DM, Kermani F, et al. Dermal mast cell activation by autoantibodies against the high affinity IgE receptor in chronic urticaria. J Invest Dermatol 1996; 106: Tong LJ, Balakrishnan G, Kochan JP, Kinet JP, Kaplan AP. Assessment of autoimmunity in patients with chronic urticaria. J Allergy lin Immunol 1997; 99: Fiebiger E, Hammerschmid F, Stingl G, Maurer D. Anti- FcepsilonRIalpha autoantibodies in autoimmune-mediated disorders. Identification of a structure-function relationship. J lin 7 3 Invest 1998; 101: Hor n MP, Gerster T, Ochensberger B, et al. Human anti- FcepsilonRIalpha autoantibodies isolated from healthy donors cross-react with tetanus toxoid. Eur J Immunol 1999; 29: Soundararajan S, Kikuchi Y, Joseph K, Kaplan AP. Functional assessment of pathogenic IgG subclasses in chronic autoimmune urticaria. J Allergy lin Immunol 2005; 115: Sabroe RA, Fiebiger E, Francis DM, et al. lassification of anti-fcepsilonri and anti-ige autoantibodies in chronic idiopathic urticaria and correlation with disease severity. J Allergy lin Immunol 2002; 110: Ase ro R, Lorini M, hong SU, Zuberbier T, Tedeschi A. Assessment of histamine-releasing activity of sera from patients with chronic urticaria showing positive autologous skin test on human basophils and mast cells. lin Exp Allergy 2004; 34: aproni M, Volpi W, Giomi B, et al. hronic idiopathic and chronic autoimmune urticaria: clinical and immunopathological features of 68 subjects. Acta Derm Venereol 2004; 84: Toubi E, Kessel A, Avshovich N, et al. linical and laboratory parameters in predicting chronic urticaria duration: a prospective study of 139 patients. Allergy 2004; 59: Rose NR, Bona. Defining criteria for autoimmune diseases ( Witebsky's postulates revisited). Immunol Today 1993; 14: Grattan EH, Francis DM. Autoimmune urticar ia. Adv Dermatol 1999; 15: Grattan EH, Francis DM, Slater NGP, et al. Plasmapheresis for severe, unremitting, chronic urticaria. Lancet 1992; 339: O'Donnell BF, Barr RM, Kobza Black A, et al. Intravenous immunoglobulin in autoimmune chronic urticaria. Br J Dermatol 1998; 138: O'Donnell BF, O'Neill M, Francis DM, et al. Human leucocyte antigen class II associations in chronic idiopathic urticaria. Br J Dermatol 1999; 140: Leznoff A, Josse RG, Denburg J, Dolovich J. Association of chronic urticaria and angioedema with thyroid autoimmunity. Arch Dermatol 1983; 119: Turktas I, Gokcora N, Demirsoy S, akir N, Onal E. The association of chronic urticaria and angioedema with autoimmune thyroiditis. Int J Dermatol 1997; 36: Gaig P, Garcia-Ortega P, Enrique E, Richart. Successful treatment of chronic idiopathic urticaria associated with thyroid autoimmunity. J Investig Allergol lin Immunol 2000; 10: Zauli D, Deleonardi G, Foderaro S, et al. Thyroid autoimmunity in chronic urticaria. Allergy Asthma Proc 2001; 22: Asero R, Lorini M, Tedeschi A. Association of chronic urticaria with thyroid autoimmunity and Raynaud phenomenon with anticentromere antibodies. J Allergy lin Immunol 2003; 111 :

8 Verneuil L, Leconte, Ballet JJ, et al. Association between chronic urticaria and thyroid autoimmunity: a prospective study involving 99 patients. Dermatology 2004; 208: Toubi E, Kessel A, Avshovich N, et al. linical and laboratory parameters in predicting chronic urticaria duration: a prospective study of 139 patients. Allergy 2004; 59: Kandeel AA, Zeid M, Helm T, Lillie MA, Donahue E, Ambrus JL Jr. Evaluation of chronic urticaria in patients with Hashimoto thyroiditis. J lin Immunol 2001; 21: Lanigan SW, Short P, Moult P. The association of chronic urticaria and thyroid autoimmunity. lin Exp Dermatol 1987; 12: Kikuchi Y, Fann T, Kaplan AP. Antithyroid antibodies in chronic urticaria and angioedema. J Allergy lin Immunol 2003; 112: Fusari A, olangelo, Bonifazi F, Antonicelli L. The autologous serum skin test in the follow-up of patients with chronic urticaria. Allergy 2005; 60: Rumbyrt JS, Katz JL, Schocket AL. Resolution of chronic urticaria in patients with thyroid autoimmunity. J Allergy lin Immunol 1995; 96: Aversano M, aiazzo P, Iorio G, Ponticiello L, Lagana B, Leccese F. Improvement of chronic idiopathic urticaria with L- thyroxine: a new TSH role in immune response? Allergy 2005; 60: Kozel MM, Mekkes JR, Bossuyt PM, Bos JD. Natural course of physical and chronic urticaria and angioedema in 220 patients. J Am Acad Dermatol 2001; 45: ribier B. Urticaria and hepatitis. lin Rev Allergy Immunol 2006; 30: Scully LJ, Ryan AE. Urticaria and acute hepatitis A virus infection. Am J Gastroenterol 1993; 88: Vaida GA, Goldman MA, Bloch KJ. Testing for hepatitis B virus in patients with chronic urticaria and angioedema. J Allergy lin Immunol 1983; 72: Doutre MS, Beylot, Beylot J, Bioulac P. Virus B markers in patients with chronic urticaria. 100 cases. Presse Med 1987; 16: Reichel M, Mauro TM. Urticaria and hepatitis. Lancet 1990; 336: Raychaudhuri SP, Kaplan M. hronic urticaria and hepatitis. Int J Dermatol 1995; 34: Kanazawa K, Yaoita H, Tsuda F, Okamoto H. Hepatitis virus infection in patients with urticaria. J Am Acad Dermatol 1996; 35: Smith R, aul EO. Urticaria and hepatitis. Br J Dermatol 1997; 136: Zauli D, Deleonardi G, Borlotti R, et al. hronic urticaria. Arch Dermatol 2001; 137: ribier BJ, Santinelli F, Schmitt, et al. hronic urticaria is not significantly associated with hepatitis or hepatitis G infection: a case-control study. Arch Dermatol 1999; 135: Llanos F, Raison-Peyron N, Meunier L, et al. Hepatitis virus infection in patients with urticaria. J Am Acad Dermatol 1998; 38: Doutre MS, Beylot BM, Beylot. Urticaria and hepatitis infection. Br J Dermatol 1997; 138: Wedi B, Wagner S, Werfel T, Manns MP, Kapp A. Prevalence of Helicobacter pylori-associated gastritis in chronic urticaria. Int Arch Allergy Immunol 1998; 116: Di ampli, Gasbarrini A, Nucera E, et al. Beneficial effects of Helicobacter pylori eradication on idiopathic chronic urticaria. Dig Dis Sci 1998; 43: Schnyder B, Helbling A, Pichler WJ. hronic idiopathic urticaria: natural course and association with Helicobacter pylori infection. Int Arch Allergy Immunol 1999; 119: Erel F, Sener O, Erdil A, et al. Impact of Helicobacter pylori and Giardia lamblia infections on chronic urticaria. J Investig Allergol lin Immunol 2000; 10: Federman DG, Kirsner RS, Moriarty JP, oncato J. The effect of antibiotic therapy for patients infected with Helicobacter pylori who have chronic urticaria. J Am Acad Dermatol 2003; 49: Kozel MM, Sabroe RA. hronic urticaria: aetiology, management and current and future treatment options. Drugs 2004; 64: Robertson L, Greaves MW. Responses of human skin blood vessels to synthetic histamine analogues. Br J lin Pharmacol 1978; 5: Erbagci Z. The leukotriene receptor antagonist montelukast in the treatment of chronic idiopathic urticaria: a single-blind, placebo-controlled, crossover clinical study. J Allergy lin Immunol 2002; 110: Di Lorenzo G, Pacor ML, Mansueto P, et al. Randomized placebo-controlled trial comparing desloratadine and montelukast in monotherapy and desloratadine plus montelukast in combined therapy for chronic idiopathic urticaria. J Allergy lin Immunol 2004; 114: Bagenstose SE, Levin L, Bernstein JA. The addition of zafirlukast to cetirizine improves the treatment of chronic urticaria in patients with positive autologous serum skin test results. J Allergy lin Immunol 2004; 113: Reimers A, Pichler, Helbling A, Pichler WJ, Yawalkar N. Zafirlukast has no beneficial effects in the treatment of chronic urticaria. lin Exp Allergy 2002; 32: Kaplan AP. linical practice. hronic urticaria and angioedema. N Engl J Med 2002; 346: Grattan E, O'Donnell BF, Francis DM, et al. Randomized double-blind study of cyclosporin in chronic "idiopathic" urticaria. Br J Dermatol 2000; 143: Toubi E, Blant A, Kessel A, Golan TD. 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9 35 70.Gach JE, Sabroe RA, Greaves MW, et al. Methotrexate-responsive chronic idiopathic urticaria: a report of two cases. Br J Dermatol 2001; 145: Reeves GE, Boyle MJ, Bonfield J, et al. Impact of hydroxychloroquine therapy on chronic urticaria: chronic autoimmune urticaria study and evaluation. Intern Med J 2004; 34: Vasagar K, Vonakis BM, Gober LM, Viksman A, Gibbons SP Jr, Saini SS. Evidence of in vivo basophil activation in chronic idiopathic urticaria. lin Exp Allergy 2006; 36: Vona kis BM, Vasagar K, Gibbons SP Jr, e t a l. Basophil FcepsilonRI histamine release parallels expression of Src-homology 2-containing inositol phosphatases in chronic idiopathic urticaria. J Allergy lin Immunol 2007; 119: hronic Idiopathic Urticaria hia-tse Weng, Yi-Hsing hen 1, and Ming-Fei Liu hronic idiopathic urticaria is recurrent itchy wheals with daily or almost daily occurrence for at least 6 weeks, without obvious cause. Eighty to 90% of these patients have no specific external cause for their disease, which is therefore labeled idiopathic before. It is now recognized that as many as 30-50% of patients show evidence of autoantibodies directed against either the high-affinity IgE receptor or, less frequently, against IgE. The term autoimmune urticaria is used increasingly nowadays to reflect advances in knowledge about these functional autoantibodies that activate mast cells and basophils. Autologous serum skin test is a useful in vivo screening test for autoimmune urticaria, with both sensitivity and specificity about 80%. It is generally accepted that thyroid autoimmunity is more prevalent in patients with chronic urticaria. However, antithyroid antibodies are not a direct causative agent in chronic urticaria. It appears more likely that antithyroid antibodies and anti-ige receptor antibodies are associated, but just parallel, autoimmune events. The role of infections in chronic urticaria remains intriguing but unresolved. The prevalence of Helicobacter pylori infection in chronic urticaria is similar to that found in the general population. However, patients with chronic urticaria may differ in their immune response to infections or may develop infection-induced autoreactivity/ autoimmunity. Remission or improvement of chronic urticaria after H. pylori eradication was shown is some studies. Non-sedating histamine receptor antagonists should be used as first-line agents in the treatment of these patients; however, identification of patients with autoimmune urticaria is of increasing importance because of immunotherapy. yclosporin, intravenous immunoglobulin or plasmapheresis has been reported to be successful in severely affected refractory patients. ( J Intern Med Taiwan 2008; 19: )