Allergy Asthma Immunol Res.  2019 Jan;11(1):29-42. 10.4168/aair.2019.11.1.29.

Causal Relationship Between Anti-TPO IgE and Chronic Urticaria by In Vitro and In Vivo Tests

• Sánchez J
• Sánchez A
• Cardona R

• KMID: 2426783
• DOI: http://doi.org/10.4168/aair.2019.11.1.29

Abstract

PURPOSE
Immunoglobulin (Ig) E autoantibodies against thyroid antigens such as thyroid peroxidase (TPO) have been demonstrated in chronic spontaneous urticaria (CSU) patients in higher frequency than healthy subjects. However, if these IgE autoantibodies can trigger urticaria is still a matter of study. The aim of this study was to investigate the relationship between concomitant IgE autoantibodies against thyroid antigens in CSU.
METHODS
Patients with CSU, healthy subjects and patients with autoimmune thyroid disease (ATD) were recruited. Total IgE and specific anti-TPO IgE and IgG were assessed in all subjects. The basophil activation test and skin tests with TPO were performed to demonstrate whether this antigen could selectively induce urticaria reaction in subjects with positive anti-TPO IgE.
RESULTS
Anti-TPO IgE was present in all 3 groups (CSU: 34.0%, ATD: 16.6%, healthy subjects: 8.1%). Anti-TPO IgE levels were higher in CSU patients, whereas anti-TPO IgG were higher in ATD patients. After exposure to TPO, CD203c expression from patients with CSU and anti-TPO IgE significantly increased in comparison to the other groups; 33.0% vs. 14.0% in ATD patients and 9.0% in control subjects (P < 0.05). Skin reactions with TPO were higher in patients with CSU according to the intradermal (CSU: 18.0%, ATD: 3.3%, control: 8.0%) and skin prick tests (12.0%, 0%, 0%, respectively). Passive transfer of anti-TPO IgE from a CSU patient to the skin of control subjects without anti-TPO IgE induced a positive skin reaction.
CONCLUSIONS
Anti-TPO IgE is not a specific biomarker for CSU. However, IgE against TPO plays a pathogenic role in inducing effector cell activation and skin exacerbation in some patients with CSU.

Keyword

Autoantigen; autoimmunity; hypothyroidism; IgE; thyroid peroxidase; urticaria; basophils

MeSH Terms

Autoantibodies
Autoimmunity
Basophils
Healthy Volunteers
Humans
Hypothyroidism
Immunoglobulin E*
Immunoglobulin G
Immunoglobulins
In Vitro Techniques*
Iodide Peroxidase
Skin
Skin Tests
Thyroid Diseases
Thyroid Gland
Urticaria*
Autoantibodies
Immunoglobulin E
Immunoglobulin G
Immunoglobulins
Iodide Peroxidase

Figure

• 

  Fig. 1 Anti-TPO IgE levels in each group. TPO, thyroid peroxidase; Ig, immunoglobulin; O.D., optical density; CSU, chronic spontaneous urticaria; ATD, autoimmune thyroid disease.

• 

  Fig. 2 Basophil activation test with TPO. TPO, thyroid peroxidase; Ig, immunoglobulin; CSU, chronic spontaneous urticaria; ATD, autoimmune thyroid disease.

• 

  Fig. 3 Skin tests with TPO. TPO, thyroid peroxidase; CSU, chronic spontaneous urticaria; ATD, autoimmune thyroid disease; SPT, skin prick test.

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