Exacerbating Factors in Chronic Spontaneous Urticaria

AbstractPurpose of reviewChronic spontaneous urticaria (CSU) is frequently associated with autoimmunity and is often exacerbated by several factors. These include stress, infections, colourings and preservatives in pre-packaged foods, as well as deficiency of vitamin D3 and iron. While chronic underlying infection and mental and emotional stress have been known to precede the onset of CSU, it is now clear that they can also aggravate the severity of the symptoms and perpetuate the condition. It is unclear how gastrointestinal dysbiosis affects CSU. Vitamin D3, however, can increase T regulatory function which can control a tendency to autoimmunity and inflammation. In this review, we discuss the different factors that can exacerbate established CSU, prolong the duration of the condition and encourage the need for second and third line therapy.Recent findingsWhile the precise molecular mechanism by which the above factors worsen CSU is unclear, there is some evidence that the Mas-related G protein –coupled X2 receptor (MRGPRX2) may be involved. This shows increased expression on the mast cells of patients with CSU and can be stimulated by anti-microbial host defence peptides, neuropeptides released during stress, major basic protein, eosinophil peroxidase and several peptidergic drugs. Seve ral of these agents acting in concert may overcome the threshold for mast cell activation leading to CSU.SummaryCSU is a complex condition with multiple subthreshold aetiological factors ...
Source: Current Treatment Options in Allergy - Category: Allergy & Immunology Source Type: research