Chronic idiopathic urticaria: detection of autoantbodies against FcεRI and IgE

Chronic idiopathic urticaria (CIU) is defined by the occurence of (daily) pruritic wheals for at least 6 weeks. A subset of patients (35-50%) with CIU seem to have autoantibodies against the high affinity IgE receptor (FcεRI) or against cell-bound IgE on the surface of mast cells and basophils, which could explain the typical symptoms in these patients. The identification of this subset of CIU is important for the understanding of the pathophysiology in the particular patient and may have impact for indicating more aggressive treatment, if antihistamines are not sufficient. They can be detected by an in vivo test, namely the autologous serum skin test (ASST), or by incubating the patients serum with basophils and measuring their activation/degranulation in vitro. To replace the ASST, which is a problematic test in the clinic, we established the basophil activation test (BAT) for CIU.

References:

  • Gentinetta T, Pecaric-Petkovic T, Wan D, Falcone F, Dahinden CA, Pichler WJ, Hausmann OV “In chronic urticaria individual IL-3 priming is crucial for consistent in vitro activation of donor basophils”, J Allergy Clin Immunol. 2011 Dec;128(6):1227-1234
  • Frezzolini A, Provini A, Teofoli P, Pomponi D, De Pità O. Serum-induced basophil CD63 expression by means of a tricolour flow cytometric method for the in vitro diagnosis of chronic urticaria. Allergy. 2006 Sep;61(9):1071-7
  • Ebo DG, Sainte-Laudy J, Bridts CH, Mertens CH, Hagendorens MM, Schuerwegh AJ, De Clerck LS, Stevens WJ. Flow-assisted allergy diagnosis: current applications and future perspectives. Allergy. 2006 Sep;61(9):1028-39.
  • Platzer MH, Grattan CE, Poulsen LK, Skov PS. Validation of basophil histamine release against the autologous serum skin test and outcome of serum-induced basophil histamine release studies in a large population of chronic urticaria patients. Allergy. 2005 Sep;60(9):1152-6.
  • Sheikh J. Autoantibodies to the high-affinity IgE receptor in chronic urticaria: how important are they? Curr Opin Allergy Clin Immunol. 2005 Oct;5(5):403-7.

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