Chronic spontaneous urticaria (CSU) is a diverse disease with few common comorbidities such as autoimmune diseases, drug reactions, and inducible urticaria. IgE antibodies against thyroid peroxidase (anti-TPO IgE) might be linked with few of these clinical characteristics.

The objective of this study is to discover the clinical characteristics of CSU patients due to the existence of anti-TPO IgE in serum. Anti-TPO IgE levels were measured in 100 CSU patients by the clinical control period (Urticaria Activity Score, 0 point) and exacerbation period (≥3 points). Patients with self-reported exacerbation of skin involvement by foods, physical triggers and nonsteroidal anti-inflammatory drugs (NSAIDs), undertook controlled challenge tests.

Two groups of patients were identified: (1) patients with anti-TPO IgE in the clinical control period or in an exacerbation, with 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 occurrence of positive challenge test results for inducible urticaria.

Among the first group, 3 subgroups were identified: patients with anti-TPO IgE in the clinical control period (n = 12); patients with anti-TPO IgE in the clinical control period and considerably increased levels in an urticaria exacerbation (n = 18); and patients with anti-TPO IgE only in an exacerbation (n = 13). No patient with self-reported food reactions had a positive challenge test result.

The study concluded that anti-TPO IgE is an important biomarker for distinguishing between clinical phenotypes of patients with CSU. Increase of anti-TPO IgE in exacerbation periods shows a relationship between autoantibody and the pathogenesis of urticaria.

Source: Sánchez J, Sánchez A, Cardona R. Clinical Characterization of Patients with Chronic Spontaneous Urticaria according to Anti-TPO IgE Levels. J Immunol Res. 2019; 2019:4202145. Published 2019 Dec 7. doi:10.1155/2019/4202145