4.4 Review

Chronic urticaria and the pathogenic role of mast cells

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Article Allergy

Anti-KIT antibody, barzolvolimab, reduces skin mast cells and disease activity in chronic inducible urticaria

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Summary: In this study, Barzolvolimab showed good tolerability and demonstrated significant reduction in skin mast cells and circulating tryptase levels in patients with chronic inducible urticaria (CIndU). It also improved disease control and quality of life in clinical settings.

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Chronic spontaneous urticaria: Focus on pathophysiology to unlock treatment advances

Allen Kaplan et al.

Summary: Chronic spontaneous urticaria (CSU) is a debilitating skin disease characterized by intense itchiness and recurrent wheals and angioedema. The inflammatory profiles of CSU patients' skin indicate interactions between mast cells, eosinophils, and basophils, leading to symptoms. Current therapies provide symptomatic relief but do not address the underlying skin inflammation permanently. Understanding the pathogenesis of CSU can lead to the development of targeted treatments with curative intent.

ALLERGY (2023)

Article Allergy

Anti-KIT monoclonal antibody CDX-0159 induces profound and durable mast cell suppression in a healthy volunteer study

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Summary: In this study, CDX-0159, an anti-KIT monoclonal antibody, was found to effectively suppress MCs and showed safety and long antibody exposure in healthy volunteers. Importantly, CDX-0159 also demonstrated dose-dependent profound suppression of plasma tryptase, indicating systemic MC suppression or ablation.

ALLERGY (2022)

Article Allergy

An open-label, proof-of-concept study of lirentelimab for antihistamine-resistant chronic spontaneous and inducible urticaria

Sabine Altrichter et al.

Summary: This study aimed to evaluate the safety and efficacy of Lirentelimab in patients with chronic urticaria. The results showed that Lirentelimab could improve symptoms and reduce disease activity, demonstrating good clinical efficacy.

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY (2022)

Article Allergy

The international EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria

Torsten Zuberbier et al.

Summary: The updated international guideline for urticaria was developed jointly by multiple international organizations, with participants from 50 countries and international societies, aiming to provide expert guidance on diagnostic and therapeutic approaches for different subtypes of urticaria.

ALLERGY (2022)

Review Allergy

Autoimmune chronic spontaneous urticaria

Pavel Kolkhir et al.

Summary: Chronic spontaneous urticaria (CSU) is a mast cell-driven disease characterized by recurrent wheals and/or angioedema, with two main autoimmune mechanisms: type I autoallergic CSU and type IIb autoimmune CSU. The latter is less common but more severe, and new targeted therapies are under development for CSU treatment.

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY (2022)

Article Allergy

Mast cells, cortistatin, and its receptor, MRGPRX2, are linked to the pathogenesis of chronic prurigo

Pavel Kolkhir et al.

Summary: This study found that cortistatin (CST) and Mas-related G protein-coupled receptor X2 (MRGPRX2) may contribute to the pathogenesis of chronic prurigo and are correlated with disease severity.

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY (2022)

Review Allergy

The Icatibant Outcome Survey: 10 years of experience with icatibant for patients with hereditary angioedema

Marcus Maurer et al.

Summary: This article reviews data from the ongoing Icatibant Outcome Survey (IOS) registry, demonstrating that icatibant is effective in real-world settings and comparable to clinical trial efficacy. The review highlights the importance of early treatment and the effectiveness/safety of icatibant across different patient subgroups.

CLINICAL AND EXPERIMENTAL ALLERGY (2022)

Review Immunology

The Role of Crosstalk of Immune Cells in Pathogenesis of Chronic Spontaneous Urticaria

Bingjing Zhou et al.

Summary: This article summarizes the latest research progress on the crosstalk between mast cells and other immune cells, providing impetus for the development of treatment strategies for chronic spontaneous urticaria.

FRONTIERS IN IMMUNOLOGY (2022)

Review Immunology

Evidence for histamine release in chronic inducible urticaria - A systematic review

Kanokvalai Kulthanan et al.

Summary: The study systematically reviewed a large number of literature and found that histamine plays a key role in the pathogenesis of chronic inducible urticaria, but it is not the sole mediator.

FRONTIERS IN IMMUNOLOGY (2022)

Article Immunology

Inhibition of MRGPRX2 but not FcεRI or MrgprB2-mediated mast cell degranulation by a small molecule inverse receptor agonist

Maram Bawazir et al.

Summary: The MRGPRX2 receptor plays a role in hypersensitivity reactions and cutaneous conditions. The MRGPRX2 agonist C9 has shown potential in modulating MC-mediated disorders.

FRONTIERS IN IMMUNOLOGY (2022)

Article Immunology

Basophils activation of patients with chronic spontaneous urticaria in response to C5a despite failure to respond to IgE-mediated stimuli

Daiki Matsubara et al.

Summary: This article discusses the role of basophils in the pathogenesis of chronic spontaneous urticaria (CSU), as well as the critical role of the complement system in its activation.

FRONTIERS IN IMMUNOLOGY (2022)

Article Medicine, General & Internal

Urticaria

Pavel Kolkhir et al.

Summary: Urticaria is a common inflammatory skin disorder that significantly affects patient quality of life and has a large number of patients worldwide. Acute urticaria can be associated with infections or intake of drugs or foods, while chronic urticaria may be spontaneous or inducible and lasts longer.

NATURE REVIEWS DISEASE PRIMERS (2022)

Review Allergy

Urticaria in Pregnancy and Lactation

Emek Kocaturk et al.

Summary: Chronic urticaria predominantly affects women of reproductive age. Pregnancy can modulate the course of the disease due to changes in sex hormones and pregnancy-associated changes in the immune system. Limited evidence is available on the effects of pregnancy on chronic urticaria and the safety of urticaria treatments during pregnancy.

FRONTIERS IN ALLERGY (2022)

Article Immunology

The Inhibitory Receptor Siglec-8 Interacts With FcεRI and Globally Inhibits Intracellular Signaling in Primary Mast Cells Upon Activation

Wouter Korver et al.

Summary: This study reveals the inhibitory effect of Siglec-8 mAb on MC activity. Siglec-8 regulates Fc epsilon RI-induced phosphorylation events through phosphatase recruitment and interaction with Fc epsilon RI gamma, resulting in global inhibition of MCs.

FRONTIERS IN IMMUNOLOGY (2022)

Review Immunology

Understanding human mast cells: lesson from therapies for allergic and non-allergic diseases

Pavel Kolkhir et al.

Summary: The discussion focuses on the crucial roles of human mast cells in allergic and other inflammatory diseases, as well as the current and emerging therapies targeting mast cells. These therapies include monoclonal antibodies, small molecules, and other approaches to inhibit mast cell function in disease settings.

NATURE REVIEWS IMMUNOLOGY (2022)

Letter Dermatology

MRGPRX2 Activation Causes Increased Skin Reactivity in Patients with Chronic Spontaneous Urticaria

Maria Shtessel et al.

JOURNAL OF INVESTIGATIVE DERMATOLOGY (2021)

Review Allergy

Mas-related G protein-coupled receptor X2 and its activators in dermatologic allergies

Helen Kuehn et al.

Summary: MRGPRX2 is a multiligand receptor highly expressed on skin mast cells, whose agonists may serve as potential biomarkers for the progression of cutaneous inflammatory diseases and response to treatment in patients with inflammatory and pruritic skin diseases.

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY (2021)

Article Dermatology

Interleukin 17 receptor A haplotype analysis in chronic spontaneous urticaria: A preliminary study

Hesham Nada et al.

Summary: The study conducted haplotype analysis for the IL17RA gene in CSU patients, revealing that gene polymorphisms of rs4819554 and rs879577 may be associated with susceptibility to CSU, thereby aiding in predicting the disease progression and severity.

JOURNAL OF COSMETIC DERMATOLOGY (2021)

Article Dermatology

Skin-Homing Regulatory B Cells Required for Suppression of Cutaneous Inflammation

Lazaro Emilio Aira et al.

Summary: The study found that IL-10(+) Bregs in the skin play a crucial role in suppressing skin inflammation, as a decrease in IL-10(+) Bregs entering the skin leads to exacerbation of inflammation.

JOURNAL OF INVESTIGATIVE DERMATOLOGY (2021)

Review Allergy

Biologics for the Use in Chronic Spontaneous Urticaria: When and Which

Marcus Maurer et al.

Summary: The guidelines recommend the use of omalizumab in antihistamine-refractory CSU, highlighting the key role of IgE and FcεRI in the pathogenesis. The review covers mechanisms of action, biomarkers, and strategies for improving treatment efficacy, as well as exploring off-label use of other biologics. Future directions include novel biologics targeting various pathways in CSU treatment.

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE (2021)

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The Expression of IL-17, in Chronic Spontaneous Urticaria Is Linked to Semaphorin5A

Matanis Lobna et al.

Summary: Sema5A is highly expressed in the skin of patients with chronic spontaneous urticaria (CSU), which may drive the expression and effects of IL-17A. Further studies are needed to confirm the role of Sema5A in the pathogenesis of CSU.

BIOMOLECULES (2021)

Review Allergy

Markers for the involvement of endothelial cells and the coagulation system in chronic urticaria: A systematic review

Yora Mostmans et al.

Summary: This systematic review categorized and analyzed various markers of endothelial cell function in chronic urticaria, with adhesion molecules, TF, and P-selectin being the most frequently reported biomarkers in skin, and F1+2, D-dimers, and MMP-9 being the most common biomarkers in the serum of CU patients. Emerging biomarkers such as endostatin, heat shock proteins, cleaved high molecular weight kininogen, and adipokines were also identified in this study. The review contributes to the growing evidence of vascular involvement in chronic urticaria, highlighting the dysfunction of endothelial cells in different aspects of cell survival, maintenance of vascular structure, and coagulation/fibrinolysis balance.

ALLERGY (2021)

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Substance P Serves as a Balanced Agonist for MRGPRX2 and a Single Tyrosine Residue Is Required for β-Arrestin Recruitment and Receptor Internalization

Chalatip Chompunud Na Ayudhya et al.

Summary: The neuropeptide substance P activates mast cells through MrgprB2, contributing to neurogenic inflammation and pain in atopic dermatitis. Certain MRGPRX2 agonists lead to beta-arrestin recruitment, revealing a new pathway for receptor internalization and desensitization. The study highlights a tyrosine residue in the highly conserved NPxxY motif of MRGPRX2 that plays a role in both G protein- and beta-arrestin-mediated responses.

INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES (2021)

Review Allergy

The Pathogenesis of Chronic Spontaneous Urticaria: The Role of Infiltrating Cells

Ana M. Gimenez-Arnau et al.

Summary: Chronic spontaneous urticaria is characterized by non-necrotizing cellular infiltrate around small skin venules, consisting primarily of CD4(D) lymphocytes, Th2 subtype, Th1 cells, and elevated Th17 cell-derived cytokines. Various cells, including neutrophils, eosinophils, basophils, and monocytes, contribute to the inflammatory response. While corticosteroids are effective in treating CSU, they primarily act on cell margination and chemotaxis rather than affecting autoimmunity or mast cell degranulation.

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE (2021)

Article Immunology

Novel Insights on MRGPRX2-Mediated Hypersensitivity to Neuromuscular Blocking Agents And Fluoroquinolones

Jessy Elst et al.

Summary: Research has shown that certain neuromuscular blocking agents and fluoroquinolones can cause mast cell-mediated anaphylactic reactions by activating MRGPRX2, while sugammadex can attenuate drug-induced mast cell activation. Some patients treated with rocuronium develop anaphylaxis, with reactions similar to IgE-mediated allergies.

FRONTIERS IN IMMUNOLOGY (2021)

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Mast Cell Modulation of B Cell Responses: An Under-Appreciated Partnership in Host Defence

Alejandro M. Palma et al.

Summary: Mast cells are important immune cells that can greatly influence the generation and activities of B cells through the production of cytokines. They co-localize with B cells in many tissues and regulate the development and antibody production of B cells.

FRONTIERS IN IMMUNOLOGY (2021)

Article Allergy

Systemic and local evidence for complement involvement in chronic spontaneous urticaria

Mehran Alizadeh Aghdam et al.

Summary: The study found involvement of the complement system in patients with chronic spontaneous urticaria (CSU) and showed that the clinical effects of omalizumab were not correlated with the variation of complement components. This suggests that complement activation plays a role in the pathogenesis of CSU independently of omalizumab treatment.

CLINICAL AND TRANSLATIONAL ALLERGY (2021)

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The Role of Coagulation and Complement Factors for Mast Cell Activation in the Pathogenesis of Chronic Spontaneous Urticaria

Yuhki Yanase et al.

Summary: The activation of skin mast cells and peripheral basophils in patients with CSU is related to tissue factor (TF) and complement factors, and medications targeting these activated factors may represent new and effective treatments for severe and refractory CSU.
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Presence of IgE Autoantibodies Against Eosinophil Peroxidase and Eosinophil Cationic Protein in Severe Chronic Spontaneous Urticaria and Atopic Dermatitis

Jorge Sanchez et al.

Summary: The study found that IgE responses against eosinophil proteins may contribute to chronic inflammation in patients with atopic dermatitis and chronic spontaneous urticaria. Cross-reactivity between EPX and TPO could explain thyroid problems in CSU patients.

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