Allergic reactions in systemic lupus erythematosus: From pathogenic pathways to clinical practice

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with a broad range of clinical presentations. Increasingly, allergic reactions-such as urticaria, drug hypersensitivity, and severe cutaneous adverse reactions-are being recognized as potentially linked to the underlying immune dysregulation in SLE, rather than occurring coincidentally.

This review aimed to examine the immunological overlap between allergy and autoimmunity in SLE and to provide practical guidance on the evaluation and management of allergic manifestations in affected patients.

A narrative review of recent literature was conducted, with a focus on immunopathogenic mechanisms, clinical features, and therapeutic considerations relating to allergy-like symptoms in SLE.

Current evidence implicates autoreactive IgE, alterations in Fc receptor signaling, and granulocyte-mediated inflammation as contributors to both allergic and autoimmune processes in SLE. Autoreactive IgE may exacerbate disease activity via plasmacytoid dendritic cell activation and type I interferon pathways. Clinically, allergic symptoms may mimic lupus flares or infections, presenting diagnostic challenges. A structured approach to assessment-considering symptom timing, laboratory markers, and treatment response-can aid differentiation. In select cases, biologic agents such as omalizumab and dupilumab, traditionally used for allergic conditions, may hold therapeutic promise.

Allergic manifestations in SLE are often overlooked but carry important diagnostic and therapeutic implications. Greater integration of allergy and autoimmunity frameworks may improve recognition, management, and personalization of care in this complex patient group.