Urticaria crónica espontánea y autoanticuerpos, una revisión narrativa

Introduction: Chronic spontaneous urticaria is a disease that incurs costs of up to $2050 per year per patient in the United States and also impacts the quality of life both mentally and physically, causing sleep disturbances and work interruptions (1,2). It tends to persist in up to 10% of patients for more than 5 years, with most cases being idiopathic, although autoimmune, pseudoallergic, or infectious etiologies are also present (3). It was previously thought that the mast cell was the only protagonist, but it has been seen that its pathophysiology is complex, and different endotypes with varying prognoses and treatment responses have been proposed. Methods: Narrative review based on a search in the PUBMED, Web of Science, and Scielo databases. Results and Discussion: A review is presented on what is known about the endotypes; type IIb autoimmunity mediated by IgG or IgM autoantibodies against the alpha subunit of membrane IgE receptors (FceRI) or against the IgE of basophils and mast cells; and type I autoimmunity or autoallergy, mediated by IgE autoantibodies against autoallergens. It has been suggested that patients with a type IIb autoimmune endotype present a more active disease, a more prolonged course, more autoimmune comorbidities, and a lower response to the use of Omalizumab (4–6). Additionally, tests such as APST and ASST exist to guide the diagnosis of chronic spontaneous urticaria of autoimmune etiology and define the best treatment; however, more studies are needed to standardize the tests.