TY - JOUR

T1 - Autologous serum skin test reactions in chronic spontaneous urticaria differ from heterologous cell reactions

AU - Baumann, Katrine

AU - Marcelino, J.

AU - Skov, Per Stahl

AU - Santos, M. C.P.

AU - Wyroslak, I.

AU - Scheffel, J.

AU - Altrichter, S.

AU - Woetmann, A.

AU - Costa, C.

AU - Maurer, M.

PY - 2021

Y1 - 2021

N2 - Background: Autoimmune chronic spontaneous urticaria (CSU) is due to mast cell (MC)-activating autoantibodies, which are screened for by the autologous serum skin test (ASST) and basophil tests (BTs). Many CSU patients are positive in only one of these tests. How often this occurs and why is currently unknown. Objectives: To characterize the prevalence of mismatched ASST and BTs in CSU patients, and to investigate possible reasons for these mismatches. Methods: We determined the rates of ASST+/BT− and ASST−/BT+ mismatches in published CSU studies. We assessed sera from 48 CSU patients by ASST, two BTs (basophil histamine release assay, BHRA; basophil activation test, BAT), a MC histamine release assay (MCHRA) and by ex vivo skin microdialysis (SMD). Results: The ASST/BT mismatch rate in published CSU studies was 31% (ASST+/BT−: 22%, ASST−/BT+: 9%). In our patients, the ASST/BHRA and ASST/BAT mismatch rate was 35.4% (ASST+/BHRA−: 18.8% and ASST−/BHRA+: 16.7%) and 31.3% (ASST+/BAT−: 6.3% and ASST−/BAT+: 25.0%), respectively, and the two BTs were significantly correlated (P = 0.0002). The use of heterologous MCs, in vitro and in situ, instead of basophils produced similar results (MCHRA mismatch: 47.9%, ASST+/MCHRA−: 18.8%, ASST−/MCHRA+: 29.2%; SMD mismatch: 40.0%, ASST+/SMD−: 10.0% and ASST−/SMD+: 30.0%), and the MCHRA was highly correlated with SMD results (P = 0.0002). Conclusions: The ASST and BTs show divergent results in a third of CSU patients. Mismatches cannot be explained by the choice of basophil assay, the type of heterologous cells exposed to CSU serum in vitro (basophils vs. mast cells), nor the experimental setting of heterologous skin mast cells (in vitro vs. in situ). Thus, serum-induced whealing, in CSU patients, seems to involve autologous skin signals modulating MC degranulation.

AB - Background: Autoimmune chronic spontaneous urticaria (CSU) is due to mast cell (MC)-activating autoantibodies, which are screened for by the autologous serum skin test (ASST) and basophil tests (BTs). Many CSU patients are positive in only one of these tests. How often this occurs and why is currently unknown. Objectives: To characterize the prevalence of mismatched ASST and BTs in CSU patients, and to investigate possible reasons for these mismatches. Methods: We determined the rates of ASST+/BT− and ASST−/BT+ mismatches in published CSU studies. We assessed sera from 48 CSU patients by ASST, two BTs (basophil histamine release assay, BHRA; basophil activation test, BAT), a MC histamine release assay (MCHRA) and by ex vivo skin microdialysis (SMD). Results: The ASST/BT mismatch rate in published CSU studies was 31% (ASST+/BT−: 22%, ASST−/BT+: 9%). In our patients, the ASST/BHRA and ASST/BAT mismatch rate was 35.4% (ASST+/BHRA−: 18.8% and ASST−/BHRA+: 16.7%) and 31.3% (ASST+/BAT−: 6.3% and ASST−/BAT+: 25.0%), respectively, and the two BTs were significantly correlated (P = 0.0002). The use of heterologous MCs, in vitro and in situ, instead of basophils produced similar results (MCHRA mismatch: 47.9%, ASST+/MCHRA−: 18.8%, ASST−/MCHRA+: 29.2%; SMD mismatch: 40.0%, ASST+/SMD−: 10.0% and ASST−/SMD+: 30.0%), and the MCHRA was highly correlated with SMD results (P = 0.0002). Conclusions: The ASST and BTs show divergent results in a third of CSU patients. Mismatches cannot be explained by the choice of basophil assay, the type of heterologous cells exposed to CSU serum in vitro (basophils vs. mast cells), nor the experimental setting of heterologous skin mast cells (in vitro vs. in situ). Thus, serum-induced whealing, in CSU patients, seems to involve autologous skin signals modulating MC degranulation.

U2 - 10.1111/jdv.17131

DO - 10.1111/jdv.17131

M3 - Journal article

C2 - 33475206

AN - SCOPUS:85101867193

VL - 35

SP - 1338

EP - 1345

JO - Journal of the European Academy of Dermatology and Venereology

JF - Journal of the European Academy of Dermatology and Venereology

SN - 0926-9959

IS - 6

ER -