Chronic Urticaria as a New Autoimmune Disease?

  • Malcolm W. Greaves


Urticaria is conventionally classified as acute, intermittent and chronic (Greaves 2000a). Acute urticaria which frequently involves an IgE-mediated immunological mechanism, is common, its causes often recognised by the patient, and will not be considered further. Intermittent urticaria — frequent bouts of unexplained urticaria at intervals of weeks or months — will be discussed here on the same basis as ‘ordinary’ chronic urticaria. The latter is conventionally defined as the occurrence of daily or almost daily whealing for at least six weeks. The etiology of chronic urticaria is usually obscure. The different clinical varieties of chronic urticaria will be briefly considered here, and attention will be devoted to a newly emerged entity — autoimmune chronic urticaria, since establishing this diagnosis has conceptual, prognostic and therapeutic implications. Contact urticaria and angioedema without urticaria will not be dealt with in this account.


Allergy Clin Immunol Chronic Urticaria Chronic Idiopathic Urticaria Urticarial Vasculitis Lung Mast Cell 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Adams DD (1988) Long-acting thyroid stimulator: how receptor autoimmunity was discovered. J Autoimmunity 1: 3–9Google Scholar
  2. Bentley-Phillips CB, Black AK, Greaves MW (1976) Induced tolerance in cold urticaria caused by cold-evoked histamine release. Lancet 11: 63–66CrossRefGoogle Scholar
  3. Black AK, Lawlor F, Greaves MW (1996) Consensus meeting on the definition of physical urticarias and urticarial vasculitis. Clin Exp Dermatol 21: 424–426PubMedCrossRefGoogle Scholar
  4. Burova GP, Mallet AI, Greaves MW (1998) Is Helicobacter pylori a cause of chronic urti caria? Br J Dermatol 139 (Suppl): 42Google Scholar
  5. Commens CA, Greaves MW (1978) Tests to establish the diagnosis in cholinergic urticaria. Brit J Dermatol 98: 47–51CrossRefGoogle Scholar
  6. Fiebiger E, Maurer D, Holubar H, Reininger B, Hartmann G, Woisetschlager M, Stingl G (1995) Serum IgG autoantibodies directed against the alpha chain of FcERI: a selective marker and pathogenetic factor for a distinct subset of chronic urticaria patients. J Clin Invest 96: 2606–2612PubMedCrossRefGoogle Scholar
  7. Fiebiger E, Hammerschmid F, Stingl G, Maurer D (1998) Anti- FcERIa autoantibodies in autoimmune-mediated disorders. J Clin Invest 101: 243–261PubMedCrossRefGoogle Scholar
  8. Fung-Leung W-P, Sousa-Hitzien JD, Ishaque A (1996) Transgenic mice expressing the human high affinity immunoglobulin ( Ig)E receptor a chain, respond to human IgE in mast cell degranulation and allergic reactions. J Exp Med 183: 49–56Google Scholar
  9. Grattan CEH, Wallington TB, Warin RP (1986) A serological mediator in chronic idiopathic urticaria: a clinical immunological and histological evaluation. Br J Dermatol 114: 583–590PubMedCrossRefGoogle Scholar
  10. Grattan CEH, Francis DM, Slater NGP, Greaves MW (1992) Plasmapheresis for severe unremitting chronic urticaria. Lancet 339: 1078–1080PubMedCrossRefGoogle Scholar
  11. Grattan CEH, Francis DM (1999) Autoimmune urticaria. Advances Dermatol 15, 311–340Google Scholar
  12. Grattan CEH, O’Donnell BF, Francis DM, Niimi N, Barlow RJ, Seed PT, Black AK, Greaves MW (2000) Randomised double blind study of cyclosporin in chronic idiopathic urticaria. Br J Dermatol 143: 365–372PubMedCrossRefGoogle Scholar
  13. Greaves MW (1995) Current concepts in chronic urticaria. New Eng J Med 332: 1767–1772PubMedCrossRefGoogle Scholar
  14. Greaves MW (2000a) Management of urticaria. Hosp Med 61: 463–469PubMedGoogle Scholar
  15. Greaves MW (2000b) Chronic urticaria. J Allergy Clin Immunol 105: 664–672PubMedCrossRefGoogle Scholar
  16. Greaves MW (2001) Chronic idiopathic urticaria (CIU) and Helicobacter pylori–not di-rectly causative, but could there be a link? Allergy Clin Immunol Internat 13: 23–26CrossRefGoogle Scholar
  17. Hayashi S Hashimoto S (1999) Anti-inflammatory actions of new antihistamines Clin Exp Allergy 29: 1593–1596CrossRefGoogle Scholar
  18. Herxheimer A (1956) The nervous pathway mediating cholinergic urticaria. Clin Sci 15: 195–205PubMedGoogle Scholar
  19. Hide M, Francis DM, Grattan CH, Greaves MW (1993) Autoantibodies against the high affinity IgE receptor as a cause for histamine release in chronic urticaria. New Eng J Med 328: 1599–1604PubMedCrossRefGoogle Scholar
  20. Hide M, Francis DM, Grattan CEH, Barr RM, Winkelmann RK, Greaves MW (1994) The pathogenesis of chronic urticaria: new evidence suggests an autoimmune basis and implications for treatment. Clin Exp Allergy 24: 624–627PubMedCrossRefGoogle Scholar
  21. Hirschmann JV, Lawlor F, English SJC, Lowback JB, Winkelmann RK, Greaves MW (1987) Cholinergic urticaria. Arch Dermatol 123: 462–467PubMedCrossRefGoogle Scholar
  22. Holgate ST Bradding P Sampson AP (1996) Leukotriene antagonists and synthesis inhibitors: new directions in asthma therapy. J Allergy Clin Immunol 98: 1–13CrossRefGoogle Scholar
  23. Juhlin L, Michaelsson G (1969) Cutaneous reactions to kallikrein, bradykinin and histamine in healthy subjects and in patients with urticaria. Acta Derm Venereol (Stockh) 49: 26–36Google Scholar
  24. Keahey TM, Greaves MW (1980) Cold urticaria: dissociation of cold-evoked histamine release and urticaria following cold challenge. Arch Dermatol 116: 174–177PubMedCrossRefGoogle Scholar
  25. Kermani F, Niimi N, Francis DM, Barr RM, Black AK, Greaves MW (1995) Characterisation of a novel mast cell-specific histamine-releasing activity in chronic idiopathic urticaria. J Invest Dermatol 105: 452Google Scholar
  26. Koro O, Dover JS, Francis DM, Black AK, Kelly RW, Barr RM, Greaves MW (1986) Release of prostaglandin D2 and histamine in a case of localised heat urticaria, and effect of treatment. Br J Dermatol 115: 721–728PubMedCrossRefGoogle Scholar
  27. Lawlor F, Black AK, Milford Ward A, Morris R, Greaves MW (1989a) Delayed pressure urti-caria: objective evaluation of a variable disease using a dermographometer and assessment of treatment using colchicine. Br J Dermatol 120: 403–408PubMedCrossRefGoogle Scholar
  28. Lawlor F, Black AK, Breathnach AS, Greaves MW (1989b) Vibratory angioedema: lesion induction, clinical features, ultrastructural findings and response to therapy. Br J Dermatol 120: 93–99PubMedCrossRefGoogle Scholar
  29. Lawrence CM, Jorizzo JL, Black AK, Coutts A, Greaves MW (1981) Cholinergic urticaria associated with angioedema. Br J Dermatol 105: 543–550PubMedCrossRefGoogle Scholar
  30. Leznoff A, Josse RG, Denburg J, Dolovich J (1983) Association of chronic urticaria and angioedema with thyroid autoimmunity. Arch Dermatol 119: 636–640PubMedCrossRefGoogle Scholar
  31. Leznoff A, Sussman GL (1989) Syndrome of idiopathic chronic urticaria and angioedema with thyroid autoimmunity–a study of 90 patients. J Allergy Clin Immunol 84: 66–71PubMedCrossRefGoogle Scholar
  32. Lowman MA, Rees PH, Benyon RC (1988) Human mast cell heterogeneity. Histamine release from mast cells dispersed from skin, lung, adenoids, tonsils and colon in response to IgE-dependent and non-immunological stimuli. J Allergy Clin Immunol 81: 590–597Google Scholar
  33. MacGlashan DW, Bochner BS, Adelman DC (1987) Down regulation of FccRI expression on human basophils during in vivo treatment of atopic human patients with anti-IgE antibody. J Immunol 158: 1438–1445Google Scholar
  34. May CD (1985) Are confusion and controversy about food hypersensitivity really necessary? J Allergy Clin Immunol 75: 329–333PubMedCrossRefGoogle Scholar
  35. Misch K, Black AK, Greaves MW (1983) Almosauri T, Stanworth DR, Passive transfer of cold urticaria to monkeys. Acta Derm Venereol (Stockh) 63: 163–164Google Scholar
  36. Murphy GM, Black AK, Greaves MW (1983) Persisting cholinergic erythema–a variant of cholinergic urticaria. Br J Dermatol 109: 343–348PubMedCrossRefGoogle Scholar
  37. Murphy GM, Zollman PE, Greaves MW, Winkelmann RK (1987) Symptomatic dermographism (factitious urticaria)–passive transfer experiments from human to monkey. Br J Dermatol 116: 801–804PubMedCrossRefGoogle Scholar
  38. Niimi N, Francis DM, Kermani F, Black AK, Barr RM, Grattan CEH, Greaves MW (1996) Dermal mast cell activation by autoantibodies against the high affinity IgE receptor in chronic urticaria. J Invest Dermatol 106: 1001–1006PubMedCrossRefGoogle Scholar
  39. O’Donnell BF, Black AK (1995) Urticarial vasculitis. Int Angiol 14: 166–174PubMedGoogle Scholar
  40. O’Donell BF, Lawlor F, Simpson J, Morgan M, Greaves MW (1997) The impact of chronic urticaria on quality of life. Br J Dermatol 136: 197–201CrossRefGoogle Scholar
  41. O’Donnell BF, Barr RM, Black AK, Francis DM, Greaves MW (1998) Intravenous immunoglobulin in chronic autoimmune urticaria. Br J Dermatol 138: 101–6PubMedCrossRefGoogle Scholar
  42. O’Donnell BF, O’Neill CM, Francis DM, Niimi N, Barr RM, Barlow RJ, Greaves MW, Welsh K (1999) Human leucocyte antigen class II associations in chronic idiopathic urticaria. Br J Dermatol 140: 853–858PubMedCrossRefGoogle Scholar
  43. Ozkaya-Bayazit E, Demir K, Ozgaroglu E, Kaymakoglu S, Ozamagar G (1998) Helicobacter pylori eradication in patients with chronic urticaria. Arch Dermatol 314: 1165–1166CrossRefGoogle Scholar
  44. Pastorello EA (1995) Evaluating new tests for the diagnosis of food allergy. Allergy 50: 289–291PubMedCrossRefGoogle Scholar
  45. Pirisi A (2000) Antihistamines impair driving as much as alcohol. Lancet 355: 905CrossRefGoogle Scholar
  46. Ramsay CA (1977) Solar urticaria treatment by inducing tolerance to artificial radiation and natural light. Arch Dermatol 113: 1222–1225PubMedCrossRefGoogle Scholar
  47. Rorsman H (1961) Basopenia in urticaria. Acta Allergol 16: 185–215PubMedCrossRefGoogle Scholar
  48. Sabroe RA, Francis DM, Barr RM, Black AK, Greaves MW (1998) Anti- FccRI autoantibodies and basophil histamine release ability in chronic idiopathic urticaria. J Allergy Clin Immunol 102: 651–658PubMedCrossRefGoogle Scholar
  49. Sabroe RA, Seed PT, Francis DM, Barr RM, Black AK, Greaves MW (1999a) Chronic idiopathic urticaria: comparison of clinical features of patients with or without anti- FccRI or anti-IgE autoantibodies. J Am Acad Dermatol 40: 443–450PubMedCrossRefGoogle Scholar
  50. Sabroe RA, Poon E, Orchard GE, Lane D, Francis DM, Barr RM, Black AK, Greaves MW (1999b) Cutaneous inflammatory cell infiltrate in chronic idiopathic urticaria: comparison of patients with and without anti-Fc RIa or anti-IgE autoantibodies. J Allergy Clin Immunol 103: 484–493PubMedCrossRefGoogle Scholar
  51. Sabroe RA, Grattan CEH, Francis DM, Black AK, Barr RM, Greaves MW (1999c) The autologous serum skin test: a screening test for autoantibodies in chronic idiopathic urticaria. Br J Dermatol 140: 446–452PubMedCrossRefGoogle Scholar
  52. Schnyder B, Helbling A, Pichler WJ (1999) Chronic idiopathic urticaria: natural course and association with Helicobacter pylori infection. Int Arch Allergy Immunol 119: 60–63PubMedCrossRefGoogle Scholar
  53. Sibbald RG, Black AK, Eady RAJ, James M, Greaves MW (1981) Aquagenic Urticaria: evidence of a cholinergic and histaminergic basis. Br J Dermatol 105: 297–302PubMedCrossRefGoogle Scholar
  54. Tong LJ, Balakrishnan G, Kochan JP, Kinet J-P, Kaplan AP (1997) Assessment of auto immunity in chronic urticaria. J Allergy Clin Immunol 99: 461–465PubMedCrossRefGoogle Scholar
  55. Wedi B, Wagner S, Werfil T, Mann MP, Kapp A (1998) Prevalence of Helicobacter pyloriassociated gastritis in chronic urticaria. Int Arch Allergy Immunol 116: 288–294PubMedCrossRefGoogle Scholar
  56. Weiner HL (1997) Oral tolerance immune mechanisms and treatment of autoimmune diseases. Immunol Today 18: 335–343PubMedCrossRefGoogle Scholar
  57. Wolfrom E, Chene G, Boisseau H, Beylot C, Geniaux M, Taleb A (1995) Chronic urticaria and Toxocara canis. Lancet 345: 196PubMedCrossRefGoogle Scholar
  58. Zuberbier T, Bohm M, Czarnetski BM (1993) Food intake in combination with a rise in body temperature: a newly defined cause of angioedema. J Allergy Clin Immunol 91: 1226–1227.PubMedCrossRefGoogle Scholar
  59. Zweiman B, Valenzano M, Atkins PC, Tanus T, Getsy JA (1996) Characteristics of histamine-releasing activity in sera of patients with chronic idiopathic urticaria. J Allergy Clin Immunol 98: 89–98PubMedCrossRefGoogle Scholar

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© Springer-Verlag Wien 2001

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  • Malcolm W. Greaves

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