From the Guidelines
Autoimmune urticaria associated with anti-Ro antibodies should be managed with a stepped approach, starting with optimal conventional treatments, and considering immunomodulating therapies only in patients with disabling disease who have not responded to these treatments. The presence of anti-Ro antibodies in patients with autoimmune urticaria indicates a potential autoimmune mechanism involving immune complex formation and complement activation, leading to mast cell degranulation and urticarial symptoms 1.
Key Considerations
- First-line treatment typically includes non-sedating H1 antihistamines, which may be increased up to four times the standard dose if needed.
- For patients with inadequate response to antihistamines, omalizumab is recommended as a second-line therapy.
- In cases with confirmed autoimmune etiology involving anti-Ro antibodies, immunosuppressive therapies such as cyclosporine, hydroxychloroquine, or methotrexate may be considered, but should be restricted to patients with disabling disease who have not responded to optimal conventional treatments 1.
Associated Conditions
- Patients should be evaluated for associated conditions like Sjögren's syndrome or systemic lupus erythematosus, as anti-Ro antibodies are commonly found in these disorders.
Treatment Approach
- The treatment approach should address both the autoimmune component and symptom management, with a focus on improving quality of life and reducing morbidity and mortality.
- Immunomodulating therapies for chronic autoimmune urticaria should be used judiciously, based on the severity of the disease and the patient's response to conventional treatments 1.
From the Research
Autoimmune Urticaria and Anti-Ro Antibodies
- Autoimmune urticaria is a condition where the immune system produces autoantibodies that attack the body's own cells, leading to chronic urticaria 2.
- The autoantibodies in autoimmune urticaria are typically directed against the high-affinity IgE receptor or IgE itself 3, 2.
- There is no direct mention of anti-Ro antibodies in the provided studies, suggesting that the relationship between autoimmune urticaria and anti-Ro antibodies is not well-established in these studies.
- Treatment options for autoimmune urticaria include antihistamines, corticosteroids, immunosuppressive drugs, and omalizumab, an anti-IgE therapy 3, 4, 5, 6.
Treatment Options
- Antihistamines, such as cetirizine and fexofenadine, are commonly used to treat chronic urticaria 3, 6.
- Corticosteroids, such as prednisone, may be used to treat severe cases of urticaria that are unresponsive to antihistamines 3.
- Immunomodulatory drugs, such as cyclosporine, may be used to treat severe and recalcitrant cases of autoimmune urticaria 3, 5.
- Omalizumab has been shown to be effective in treating refractory cases of chronic autoimmune urticaria 4, 5, 6.
Diagnosis and Pathogenesis
- The diagnosis of autoimmune urticaria is typically made using the autologous serum skin test or the basophil mediator release assay 2.
- The pathogenesis of autoimmune urticaria involves the production of autoantibodies that activate mast cells and basophils, leading to the release of histamine and other mediators 5, 2.