Kolkhir Pavel, Church Martin K, Altrichter Sabine, Skov Per Stahl, Hawro Tomasz, Frischbutter Stefan, Metz Martin, Maurer Marcus
Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Division of Immune-Mediated Skin Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
J Allergy Clin Immunol Pract. 2020 Jan;8(1):318-325.e5. doi: 10.1016/j.jaip.2019.08.025. Epub 2019 Aug 28.
Chronic spontaneous urticaria (CSU) is characterized by the degranulation of skin mast cells and the influx of basophils and eosinophils to affected skin sites. Blood basopenia has been linked to severe antihistamine-resistant CSU and type IIb autoimmunity, whereas the role of eosinophils in CSU is largely unknown.
To analyze data from 1613 patients with CSU from 2 centers to study the prevalence, role, and relevance of eosinopenia in CSU.
Peripheral blood eosinophil and basophil counts were measured by automated hematology analyzers. Patient files were screened for clinical characteristics, results of laboratory tests, the autologous serum skin test, the serum-induced basophil histamine release assay, and response to second-generation H-antihistamines and omalizumab.
Ten percent of patients with CSU had eosinopenia. Eosinopenia was associated with the female sex, high disease activity, autologous serum skin test and basophil histamine release assay positivity, low total IgE, and high levels of C-reactive protein and IgG-antithyroperoxidase (P ≤ .007). Nonresponders to second-generation H-antihistamines or omalizumab had significantly lower eosinophils as compared with responders (P < .05 and P < .01, respectively). Blood eosinophil counts correlated with basophil counts (r = 0.396; P < .001), and 81% of patients with CSU with undetectable eosinophils had basopenia. The combination of eosinopenia and basopenia is a better predictor of nonresponse to second-generation H-antihistamines than eosinopenia alone (odds ratio of 9.5 vs 4.8).
Eosinopenia in patients with CSU is associated with type IIb autoimmunity, high disease activity, and poor response to treatment. Eosinophils should be explored as biomarkers and investigated for their contribution to the pathogenesis of CSU.
慢性自发性荨麻疹（CSU）的特征是皮肤肥大细胞脱颗粒以及嗜碱性粒细胞和嗜酸性粒细胞流入受影响的皮肤部位。血嗜碱性粒细胞减少与严重的抗组胺药抵抗性CSU和IIb型自身免疫有关，而嗜酸性粒细胞在CSU中的作用在很大程度上尚不清楚。
分析来自2个中心的1613例CSU患者的数据，以研究嗜酸性粒细胞减少在CSU中的患病率、作用及相关性。
通过自动血液分析仪测量外周血嗜酸性粒细胞和嗜碱性粒细胞计数。筛查患者病历以获取临床特征、实验室检查结果、自体血清皮肤试验、血清诱导的嗜碱性粒细胞组胺释放试验以及对第二代H-抗组胺药和奥马珠单抗的反应。
10%的CSU患者存在嗜酸性粒细胞减少。嗜酸性粒细胞减少与女性、高疾病活动度、自体血清皮肤试验和嗜碱性粒细胞组胺释放试验阳性、低总IgE以及高C反应蛋白和IgG-抗甲状腺过氧化物酶水平相关（P≤0.007）。与有反应者相比，对第二代H-抗组胺药或奥马珠单抗无反应者的嗜酸性粒细胞明显更低（分别为P<0.05和P<0.01）。血嗜酸性粒细胞计数与嗜碱性粒细胞计数相关（r = 0.396；P<0.001），81%嗜酸性粒细胞检测不到的CSU患者存在嗜碱性粒细胞减少。嗜酸性粒细胞减少和嗜碱性粒细胞减少共同存在比单独嗜酸性粒细胞减少更能预测对第二代H-抗组胺药无反应（比值比为9.5对4.8）。
CSU患者的嗜酸性粒细胞减少与IIb型自身免疫、高疾病活动度和治疗反应差有关。应探索嗜酸性粒细胞作为生物标志物，并研究其对CSU发病机制的作用。
