Toubi Elias, Vadasz Zahava
The Outpatient Allergy Clinic, The Holy Family Hospital, Nazareth, Israel.
The Proteomic Unit, The Division of Clinical Immunology, Bnai-Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel.
Immunotargets Ther. 2020 Oct 22;9:217-223. doi: 10.2147/ITT.S266410. eCollection 2020.
Chronic spontaneous urticaria (CSU) is considered to be an autoimmune disorder (type I and type II) in 50% of all cases. However, autoreactive T cells and their proximity with activated mast cells in the skin of CSU patients are believed to be the primary event in mast cell degranulation. The finding of anti-FcɛRIα on mast cells or IgE autoantibodies against thyroid antigens should be considered to be a consequence of the auto-reactive T cells' recognition of the above-mentioned antigens. Our recent finding of increased Th17 and IL-17 expression in both CD4+ T cells and mast cells in the skin of severe CSU patients is supportive for the major role that T cells perform in the pathogenesis of CSU. Supporting this are numerous previous reports in which increased serum IL-17 was found to be in association with CSU disease severity. The beneficial effect of anti-IL-17A (secukinumab) in CSU patients in whom high dose anti-histamines, recurrent course of steroids and omalizumab fail to achieve a reasonable response should be investigated as a new therapeutic strategy in future studies with a large cohort of patients.
在所有慢性自发性荨麻疹（CSU）病例中，50%被认为是自身免疫性疾病（I型和II型）。然而，CSU患者皮肤中自身反应性T细胞及其与活化肥大细胞的接近程度被认为是肥大细胞脱颗粒的主要事件。在肥大细胞上发现抗FcɛRIα或针对甲状腺抗原的IgE自身抗体应被视为自身反应性T细胞识别上述抗原的结果。我们最近发现，重度CSU患者皮肤中的CD4+T细胞和肥大细胞中Th17和IL-17表达增加，这支持了T细胞在CSU发病机制中发挥的主要作用。此前有许多报道支持这一点，其中发现血清IL-17升高与CSU疾病严重程度相关。对于高剂量抗组胺药、反复使用类固醇和奥马珠单抗均未能取得合理疗效的CSU患者，抗IL-17A（司库奇尤单抗）的有益作用应作为一种新的治疗策略在未来针对大量患者的研究中进行调查。
