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Presence of positive skin prick tests to inhalant allergens and markers of T2 inflammation in subjects with chronic spontaneous urticaria (CSU): a systematic literature review.
Allergy, Asthma & Clinical Immunology ( IF 2.7 ) Pub Date : 2020-08-04 , DOI: 10.1186/s13223-020-00461-x
Melanie Mitsui Wong 1 , Paul Kevin Keith 2
Affiliation  

Current guidelines do not recommend performing aeroallergen skin prick testing (SPT) in chronic spontaneous urticaria (CSU). The objective of this review was to investigate the presence of aeroallergen sensitization and markers of T2 inflammation in subjects with CSU. Systematic literature reviews to identify all studies that evaluated the presence of T2 markers of allergic inflammation in CSU subjects were performed. In 16 studies that assessed the prevalence of positive SPT to multiple aeroallergens in CSU, 38.5% of CSU subjects had positive SPT. In three controlled studies, 34.2% of CSU subjects had positive SPT to multiple aeroallergens, compared to 13.6% of controls (p = 0.047). In 18 studies that assessed the prevalence of house dust mite (HDM) positive SPT in CSU, 27.5% of CSU subjects had positive SPT. In three controlled studies, 27.5% of CSU subjects had positive SPT to HDM, compared to 2.1% of controls (p = 0.047). Overall, CSU subjects were 3.1 times more likely to be aeroallergen-sensitized (95% CI 1.7–5.8, p = 0.0002) and 6.1 times more likely to be HDM-sensitized (95% CI 3.7–9.9, p < 0.00001) than controls. Mean total serum IgE (tIgE) levels were 238 kU/L and median tIgE levels were 164 kU/L, which was greater than the upper 90th percentile of normal (< 137 kU/L). Compared to healthy controls, CSU subjects were 6.5 times more likely to have IgG autoantibody against FcεR1α (p = 0.001), 2.4 times more likely to have IgG anti-IgE antibody (p = 0.03) and 5 times more likely to have anti-thyroid peroxidase (anti-TPO) antibody (p = 0.02). When corticosteroids were withheld for ≥ 28 days, mean blood eosinophil percentage was elevated at 5.9% (normal < 4%), but other studies reporting absolute count found the mean was in the normal range, 239 $$\times 10^{6} /$$ L (normal < 400 $$\times 10^{6} /$$ L). Increased aeroallergen sensitization, tIgE, autoantibodies and blood eosinophil percentage in the CSU subjects indicates the possible importance of T2 inflammation in the pathogenesis of CSU. Further studies may be warranted to determine if specific allergen avoidance, desensitization or improvement in the mucosal allergic inflammation present in asthma and/or rhinitis has any benefit in the management of CSU.

中文翻译:

慢性自发性荨麻疹 (CSU) 受试者吸入性过敏原和 T2 炎症标志物的皮肤点刺试验阳性:系统文献综述。

目前的指南不建议对慢性自发性荨麻疹 (CSU) 进行气源性过敏原皮肤点刺试验 (SPT)。本综述的目的是调查 CSU 受试者是否存在气源性过敏原致敏和 T2 炎症标志物。进行了系统的文献回顾,以确定所有评估 CSU 受试者过敏性炎症 T2 标志物存在的研究。在 16 项评估 CSU 中多种气源性过敏原 SPT 阳性患病率的研究中,38.5% 的 CSU 受试者 SPT 阳性。在三项对照研究中,34.2% 的 CSU 受试者对多种气源性过敏原的 SPT 呈阳性,而对照组为 13.6% (p = 0.047)。在评估 CSU 中屋尘螨 (HDM) 阳性 SPT 患病率的 18 项研究中,27.5% 的 CSU 受试者的 SPT 阳性。在三项对照研究中,27。5% 的 CSU 受试者对 HDM 的 SPT 呈阳性,而对照组为 2.1% (p = 0.047)。总体而言,与对照组相比,CSU 受试者对空气过敏原致敏的可能性高 3.1 倍(95% CI 1.7-5.8,p = 0.0002),对 HDM 致敏的可能性高 6.1 倍(95% CI 3.7-9.9,p < 0.00001) . 平均总血清 IgE (tIgE) 水平为 238 kU/L,中位 tIgE 水平为 164 kU/L,高于正常值的上 90% (< 137 kU/L)。与健康对照组相比,CSU 受试者产生针对 FcεR1α 的 IgG 自身抗体的可能性高 6.5 倍(p = 0.001),产生 IgG 抗 IgE 抗体的可能性高 2.4 倍(p = 0.03),产生抗甲状腺抗体的可能性高 5 倍过氧化物酶(抗 TPO)抗体(p = 0.02)。当皮质类固醇停用 ≥ 28 天时,平均血嗜酸性粒细胞百分比升高至 5.9%(正常 < 4%),但其他报告绝对计数的研究发现平均值在正常范围内,239 $$\times 10^{6} /$$ L(正常 < 400 $$\times 10^{6} /$$ L)。CSU 受试者的气源性过敏原致敏、tIgE、自身抗体和血嗜酸性粒细胞百分比增加表明 T2 炎症在 CSU 发病机制中的可能重要性。可能需要进一步的研究来确定特定的过敏原避免、脱敏或改善哮喘和/或鼻炎中存在的粘膜过敏性炎症是否对 CSU 的管理有任何益处。CSU 受试者的自身抗体和血嗜酸性粒细胞百分比表明 T2 炎症在 CSU 发病机制中的可能重要性。可能需要进一步的研究来确定特定的过敏原避免、脱敏或改善哮喘和/或鼻炎中存在的粘膜过敏性炎症是否对 CSU 的管理有任何益处。CSU 受试者的自身抗体和血嗜酸性粒细胞百分比表明 T2 炎症在 CSU 发病机制中的可能重要性。可能需要进一步的研究来确定特定的过敏原避免、脱敏或改善哮喘和/或鼻炎中存在的粘膜过敏性炎症是否对 CSU 的管理有任何益处。
更新日期:2020-08-05
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