Intravenous immunoglobulin in autoimmune chronic urticaria

Area of Science:

• Immunology
• Dermatology
• Allergy and Clinical Immunology

Background:

• Histamine-releasing autoantibodies are implicated in chronic urticaria (CU) pathogenesis in about 30% of patients.
• Autoimmune CU is characterized by specific diagnostic markers, including autologous serum skin tests and in vitro histamine release.
• Severe autoimmune CU often shows poor response to conventional treatments.

Purpose of the Study:

• To evaluate the therapeutic efficacy of high-dose intravenous immunoglobulin (IVIG) in patients with severe autoimmune chronic urticaria.
• To assess the impact of IVIG on disease activity, including skin wealing and itch.
• To determine the safety and tolerability of IVIG treatment in this patient population.

Main Methods:

• Ten patients with severe, treatment-refractory autoimmune CU were enrolled.
• Treatment involved high-dose IVIG (0.4 g/kg/day for 5 days).
• Disease activity was monitored using urticaria activity scores, visual analogue scales, and autologous intradermal serum tests before and after treatment.

Main Results:

• Nine out of ten patients showed clinical benefit from IVIG treatment.
• Significant improvements in urticaria activity scores and visual analogue scales were observed at 2 and 6 weeks post-treatment (P < 0.01).
• Reduced weal-and-flare responses to autologous serum tests indicated diminished disease activity, with three patients achieving prolonged remission.

Conclusions:

• High-dose IVIG is a promising therapeutic option for selected patients with recalcitrant chronic urticaria linked to histamine-releasing autoantibodies.
• IVIG treatment led to significant clinical improvement and reduced immunological markers of disease activity.
• The treatment was generally well-tolerated, with minor side effects and no serious adverse events reported.