McEvoy M T, Peterson E A, Kobza-Black A, English J S, Dover J S, Murphy G M, Bhogal B, Greaves M W, Winkelmann R K, Leiferman K M
Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA.
Br J Dermatol. 1995 Dec;133(6):853-60. doi: 10.1111/j.1365-2133.1995.tb06916.x.
Urticarial dermographism and delayed pressure urticaria are two forms of physical urticaria which are well defined clinically and histologically. Previous studies have shown eosinophil granule protein deposition in urticarial reactions, including chronic urticaria, solar urticaria and delayed pressure urticaria. To evaluate and compare the involvement of granulated inflammatory cells in urticarial dermographism and delayed pressure urticaria, we studied sequential biopsies of induced lesions of urticarial dermographism and delayed pressure urticaria by indirect immunofluorescence, to detect eosinophil granule major basic protein (MBP) and neutrophil granule elastase. Biopsies from dermographic lesions at time 0, 5 min, 15 min, 2 h and 24 h, showed few infiltrating eosinophils, with minimal extracellular MBP deposition, and a few infiltrating neutrophils, with minimal neutrophil elastase deposition, throughout the evolution of the lesions. Sequential biopsies of delayed pressure urticaria at time 0, 20 min, 6, 12 and 24 h, showed eosinophil infiltration with extensive MBP deposition beginning at 20 min, and neutrophil infiltration with variable elastase deposition beginning at 20 min. Control tissue specimens from normal volunteers showed neutrophil infiltration and slight degranulation, but no eosinophil infiltration or degranulation. Comparison of urticarial dermographism with delayed pressure urticaria showed marked differences in the patterns of infiltration. Delayed pressure urticaria, with eosinophil and neutrophil degranulation, was strikingly similar to the IgE-mediated late phase reaction. In contrast, eosinophil and neutrophil involvement in urticarial dermographism was minimal. Considering the extent of eosinophil granule protein deposition and the biological activities of the eosinophil granule proteins, the findings in delayed pressure urticaria point to an important pathophysiological role of eosinophils in the disease.
人工荨麻疹和迟发性压力性荨麻疹是物理性荨麻疹的两种形式，在临床和组织学上都有明确的定义。先前的研究表明，嗜酸性粒细胞颗粒蛋白在荨麻疹反应中沉积，包括慢性荨麻疹、日光性荨麻疹和迟发性压力性荨麻疹。为了评估和比较颗粒状炎症细胞在人工荨麻疹和迟发性压力性荨麻疹中的参与情况，我们通过间接免疫荧光研究了人工荨麻疹和迟发性压力性荨麻疹诱导皮损的连续活检，以检测嗜酸性粒细胞颗粒主要碱性蛋白（MBP）和中性粒细胞颗粒弹性蛋白酶。人工荨麻疹皮损在0、5分钟、15分钟、2小时和24小时的活检显示，在皮损演变过程中，浸润的嗜酸性粒细胞很少，细胞外MBP沉积极少，浸润的中性粒细胞也很少，中性粒细胞弹性蛋白酶沉积极少。迟发性压力性荨麻疹在0、20分钟、6、12和24小时的连续活检显示，从20分钟开始出现嗜酸性粒细胞浸润并伴有广泛的MBP沉积，从20分钟开始出现中性粒细胞浸润并伴有可变的弹性蛋白酶沉积。正常志愿者的对照组织标本显示有中性粒细胞浸润和轻微脱颗粒，但没有嗜酸性粒细胞浸润或脱颗粒。人工荨麻疹与迟发性压力性荨麻疹的比较显示，浸润模式存在明显差异。迟发性压力性荨麻疹伴有嗜酸性粒细胞和中性粒细胞脱颗粒，与IgE介导的迟发性反应极为相似。相比之下，嗜酸性粒细胞和中性粒细胞在人工荨麻疹中的参与程度极小。考虑到嗜酸性粒细胞颗粒蛋白沉积的程度以及嗜酸性粒细胞颗粒蛋白的生物学活性，迟发性压力性荨麻疹的研究结果表明嗜酸性粒细胞在该疾病中具有重要的病理生理作用。
