Clinicopathologic findings in (anti-FcepsilonR1alpha) autoimmune-related chronic urticaria.
BACKGROUND
One cause of chronic urticaria is autoreactivity which is diagnosed by detecting autoantibodies against the IgE receptor alpha subunit (anti-Fc R1alpha).


OBJECTIVE
To compare the histopathologic features of chronic urticaria patients testing positive for anti-IgE receptor antibody (Ab) to those testing negative.


METHODS
Totally, 438 patients with a clinical presentation of chronic urticaria (2011-2013) had anti-IgE receptor Ab tested and 37 of those patients had skin biopsy. We evaluated microscopic features including: spongiosis, dermal edema, presence of mast cells, density of lymphocytic infiltration, predomination of eosinophils/neutrophils; intravascular neutrophils and presence of vasculitis. The aforementioned features were compared between negative and positive anti-IgE receptor Ab groups.


RESULTS
Of 37 patients , 69% were women and 31% were men. 49% had positive anti-IgE receptor Ab and 51% had negative anti-IgE receptor Ab. In the positive anti-IgE receptor Ab group, 83% showed intravascular neutrophils. Eosinophil predominance was identified in 72% and neutrophil predominance was identified in 28%. In the negative anti-IgE receptor Ab group, 89% showed intravascular neutrophils. Eosinophil predominance was identified in 53% and neutrophil predominance was identified in 47%. There was no evidence of vasculitis in either group.


CONCLUSIONS
There were no significant histopathologic differences between the anti-IgE receptor Ab positive and negative cases. Therefore, serum testing for anti-IgE receptor Ab is required to identify this subgroup of chronic urticaria patients.
Department of Pathology, NorthShore University HealthSystem, Evanston, IL, USA.|Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
Theera
T
Rojanapremsuk
Department of Dermatology, NorthShore University HealthSystem, Evanston, IL, USA.
Sarah
S
Kasprowicz
Allergy Immunology, NorthShore University HealthSystem, Evanston, IL, USA.
Ewa
E
Schafer
Allergy Immunology, NorthShore University HealthSystem, Evanston, IL, USA.
Rachel
R
Story
Department of Pathology, University of Illinois at Chicago, Chicago, IL, USA.
Michael S
MS
Clarke
Department of Pathology, NorthShore University HealthSystem, Evanston, IL, USA.|Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
Timothy
T
Walls
Department of Pathology, NorthShore University HealthSystem, Evanston, IL, USA.|Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
Vivian
V
Snyder
Department of Pathology, Path Group, Nashville, TN, USA.
Briana C
BC
Gleason
Department of Pathology, NorthShore University HealthSystem, Evanston, IL, USA.|Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
Antoinette B
AB
Thomas
Department of Pathology, NorthShore University HealthSystem, Evanston, IL, USA.|Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
Thomas
T
Cibull
D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000276:immunology*; D001323:Autoantibodies / Q000276:immunology*; D001327:Autoimmune Diseases / Q000276:immunology / Q000473:pathology; D002908:Chronic Disease; D004804:Eosinophils / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D008407:Mast Cells / Q000276:immunology / Q000473:pathology; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology; D017455:Receptors, IgE / Q000276:immunology*; D012867:Skin / Q000473:pathology; D014581:Urticaria / Q000276:immunology* / Q000473:pathology*
D000888:Antibodies, Anti-Idiotypic; D001323:Autoantibodies; C543355:FcepsilonRI alpha-chain, human; D017455:Receptors, IgE; C026408:anti-IgE antibodies
Autoantibody; Dermatitis; IgE; Urticaria